Provider Demographics
NPI:1669786414
Name:WHITE, DELIECE LEGRANDE (ACUPUNCTURE PHYS)
Entity type:Individual
Prefix:
First Name:DELIECE
Middle Name:LEGRANDE
Last Name:WHITE
Suffix:
Gender:F
Credentials:ACUPUNCTURE PHYS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 N WICKHAM RD
Mailing Address - Street 2:SUITE 116
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-2028
Mailing Address - Country:US
Mailing Address - Phone:321-626-8638
Mailing Address - Fax:
Practice Address - Street 1:6300 N WICKHAM RD
Practice Address - Street 2:SUITE 116
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-2028
Practice Address - Country:US
Practice Address - Phone:321-626-8638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-04
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP1735171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist