Individual
KEILA MABEL FATNASSI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
510 VONDERBURG DR, # 301, BRANDON, FL 33511-5954
(813) 881-1000
Mailing address
700 S HARBOUR ISLAND BLVD, UNIT # 313, TAMPA, FL 33602-5712
(813) 846-7904
Taxonomy
Speciality
Code
Description
License number
State
103TA0400X
Addiction (Substance Use Disorder) Psychologist
Primary
—
—
Other
Enumeration date
08/06/2014
Last updated
08/06/2014
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