Provider Demographics
NPI:1538430244
Name:BLAVO, DELALI OHUI (DO)
Entity type:Individual
Prefix:DR
First Name:DELALI
Middle Name:OHUI
Last Name:BLAVO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:965 RIDGE LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-9401
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:901-227-8591
Practice Address - Street 1:401 SOUTHCREST CIR STE 202
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-6719
Practice Address - Country:US
Practice Address - Phone:901-763-3636
Practice Address - Fax:662-536-2282
Is Sole Proprietor?:No
Enumeration Date:2012-01-26
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4188207RE0101X
MS23064207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism