Provider Demographics
NPI:1801036124
Name:VANDEVELDE, JENNIFER RAE (DO)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:RAE
Last Name:VANDEVELDE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:410 CELEBRATION PL
Mailing Address - Street 2:SUITE 208
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-5433
Mailing Address - Country:US
Mailing Address - Phone:407-566-2229
Mailing Address - Fax:407-566-2499
Practice Address - Street 1:410 CELEBRATION PL STE 208
Practice Address - Street 2:
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747-5434
Practice Address - Country:US
Practice Address - Phone:407-566-2229
Practice Address - Fax:407-566-2499
Is Sole Proprietor?:No
Enumeration Date:2009-02-26
Last Update Date:2017-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHBS361734185034207V00000X
FLOS14693207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology