1598267445 NPI number — DR. VINCENT MALIK DEHILI PH.D.

Table of content: DR. VINCENT MALIK DEHILI PH.D. (NPI 1598267445)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598267445 NPI number — DR. VINCENT MALIK DEHILI PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEHILI
Provider First Name:
VINCENT
Provider Middle Name:
MALIK
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598267445
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1936 BRUCE B DOWNS BLVD
Provider Second Line Business Mailing Address:
PMB 174
Provider Business Mailing Address City Name:
WESLEY CHAPEL
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33544
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-816-2766
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
146 2ND STREET NORTH
Provider Second Line Business Practice Location Address:
SUITE 305
Provider Business Practice Location Address City Name:
ST. PETERSBURG
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-308-1180
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/07/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  PY9919 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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