Provider Demographics
NPI:1750562724
Name:DELVA, GUESLY J (MD)
Entity type:Individual
Prefix:MR
First Name:GUESLY
Middle Name:J
Last Name:DELVA
Suffix:
Gender:M
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 15751
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34604-0123
Mailing Address - Country:US
Mailing Address - Phone:352-559-8849
Mailing Address - Fax:
Practice Address - Street 1:7145 MARINER BLVD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34609-1048
Practice Address - Country:US
Practice Address - Phone:352-559-8849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-19
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD73083207RI0200X
LAMD.210398207R00000X, 208000000X
FLME120716207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS062-0459OtherBC/BS REGIONAL
MD332805800Medicaid
MDP01304302Medicare PIN
MD332805800Medicaid