Provider Demographics
NPI:1770571242
Name:DULANEY, JAIMELA J (MD)
Entity type:Individual
Prefix:DR
First Name:JAIMELA
Middle Name:J
Last Name:DULANEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JAIMELA
Other - Middle Name:J
Other - Last Name:DULANEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2495 CARING WAY
Mailing Address - Street 2:SUITE C
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-5380
Mailing Address - Country:US
Mailing Address - Phone:941-235-9231
Mailing Address - Fax:941-235-9236
Practice Address - Street 1:2495 CARING WAY
Practice Address - Street 2:SUITE C
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-5380
Practice Address - Country:US
Practice Address - Phone:941-235-9231
Practice Address - Fax:941-235-9236
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-10
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0071355207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
2285331OtherAETNA
FL251821000Medicaid
5198786001OtherCIGNA
F33291Medicare UPIN
32347AMedicare ID - Type Unspecified