Provider Demographics
NPI:1861466070
Name:VANDELAC, KEVIN LEE (HS1)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:LEE
Last Name:VANDELAC
Suffix:
Gender:M
Credentials:HS1
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1519 ALASKAN WAY S
Mailing Address - Street 2:COMMANDING OFFICER ISC SEATTLE
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98134-1102
Mailing Address - Country:US
Mailing Address - Phone:360-217-6432
Mailing Address - Fax:360-217-6636
Practice Address - Street 1:1519 ALASKAN WAY S
Practice Address - Street 2:COMMANDING OFFICER ISC SEATTLE
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98134-1102
Practice Address - Country:US
Practice Address - Phone:360-217-6432
Practice Address - Fax:360-217-6636
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-14
Last Update Date:2007-07-08
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other