Provider Demographics
NPI:1649985193
Name:COELHO, VLADIA
Entity type:Individual
Prefix:DR
First Name:VLADIA
Middle Name:
Last Name:COELHO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VLADIA
Other - Middle Name:M A
Other - Last Name:COELHO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2580 JUDGE FRAN JAMIESON WAY UNIT 3230
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-6258
Mailing Address - Country:US
Mailing Address - Phone:585-743-0174
Mailing Address - Fax:
Practice Address - Street 1:3226 LAKE WASHINGTON RD STE 16
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32934-7620
Practice Address - Country:US
Practice Address - Phone:321-255-1991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-19
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN27668122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist