Provider Demographics
NPI:1386843670
Name:CANDALINO, BONNIE K (ITDS)
Entity type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:K
Last Name:CANDALINO
Suffix:
Gender:F
Credentials:ITDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 DEERFOOT RD
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-7946
Mailing Address - Country:US
Mailing Address - Phone:386-747-8089
Mailing Address - Fax:
Practice Address - Street 1:160 DEERFOOT RD
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-7946
Practice Address - Country:US
Practice Address - Phone:386-747-8089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist