Individual
MAILANDE DEDEAUX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
400 GULF BREEZE PKWY, SUITE 300, GULF BREEZE, FL 32561-4458
(850) 932-5055
(850) 932-1404
Mailing address
PO BOX 280, GULF BREEZE, FL 32562-0280
(850) 932-5055
(850) 932-1404
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA9108878
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
JL0YB
BLUE CROSS BLUE SHIELD
FL
Enumeration date
09/02/2015
Last updated
09/02/2016
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