Provider Demographics
NPI:1053793851
Name:DALESSIO, JONATHAN (DOM)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:
Last Name:DALESSIO
Suffix:
Gender:M
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 11TH SQ SW
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32962-3442
Mailing Address - Country:US
Mailing Address - Phone:772-480-9111
Mailing Address - Fax:
Practice Address - Street 1:205 11TH SQ SW
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32962-3442
Practice Address - Country:US
Practice Address - Phone:772-480-9111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-29
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL000892171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist