Basic Information
Provider Information | |||||||||
NPI: | 1043528474 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | BLESILDA H OLFATO, P A | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 4544 SHADOW LEAF DR | ||||||||
Address2: |   | ||||||||
City: | SARASOTA | ||||||||
State: | FL | ||||||||
PostalCode: | 34233 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8137547756 | ||||||||
FaxNumber: | 8137547565 | ||||||||
Practice Location | |||||||||
Address1: | 4544 SHADOWLEAF DR | ||||||||
Address2: |   | ||||||||
City: | SARASOTA | ||||||||
State: | FL | ||||||||
PostalCode: | 342332278 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8137547756 | ||||||||
FaxNumber: | 8137547565 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/20/2010 | ||||||||
LastUpdateDate: | 12/02/2010 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | OLFATO | ||||||||
AuthorizedOfficialFirstName: | BLESILDA | ||||||||
AuthorizedOfficialMiddleName: | H | ||||||||
AuthorizedOfficialTitleorPosition: | PROVIDER | ||||||||
AuthorizedOfficialTelephone: | 9419278213 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | DR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | P A | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X |   |   | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 250496100 | 05 | FL |   | MEDICAID | 110174189 | 01 | FL | MEDICARE RAILROAD | OTHER |