Provider Demographics
NPI:1205127362
Name:DALFINO, VANDLA KAY (MT)
Entity type:Individual
Prefix:
First Name:VANDLA
Middle Name:KAY
Last Name:DALFINO
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24505 HIDEOUT TRL
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34639-8119
Mailing Address - Country:US
Mailing Address - Phone:813-966-6558
Mailing Address - Fax:
Practice Address - Street 1:2008 ASHLEY OAKS CIR
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-6400
Practice Address - Country:US
Practice Address - Phone:813-907-0430
Practice Address - Fax:813-907-0963
Is Sole Proprietor?:No
Enumeration Date:2011-04-25
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 58326174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist