Provider Demographics
NPI:1922186485
Name:OLFATO, BLESILDA HIDALGO (MD)
Entity Type:Individual
Prefix:
First Name:BLESILDA
Middle Name:HIDALGO
Last Name:OLFATO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 18839
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34276-1839
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5401 SAWYER ROAD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233
Practice Address - Country:US
Practice Address - Phone:941-925-3427
Practice Address - Fax:941-925-8469
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME69777207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00011873OtherRR MEDICARE
FL2504916101Medicaid
FL31256OtherBLUE SHIELD
FL31256OtherBLUE SHIELD
FL31256AMedicare ID - Type Unspecified
FL31256YMedicare ID - Type Unspecified