Provider Demographics
NPI:1801085956
Name:DELLAVECCHIA, JAMES D (PA)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:D
Last Name:DELLAVECCHIA
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:5741 BEE RIDGE RD
Mailing Address - Street 2:SUITE 280
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-5064
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5741 BEE RIDGE RD
Practice Address - Street 2:SUITE 280
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-5064
Practice Address - Country:US
Practice Address - Phone:941-365-0655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-15
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPAT 9104309363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical