Provider Demographics
NPI:1558558825
Name:ORLANDO, BONITA SUE (MED)
Entity Type:Individual
Prefix:MISS
First Name:BONITA
Middle Name:SUE
Last Name:ORLANDO
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1614 SPINNING WHEEL DR
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33559-3346
Mailing Address - Country:US
Mailing Address - Phone:813-909-0732
Mailing Address - Fax:
Practice Address - Street 1:1614 SPINNING WHEEL DR
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33559-3346
Practice Address - Country:US
Practice Address - Phone:813-909-0732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL767102400Medicaid