Provider Demographics
NPI:1730682808
Name:ADESSO PROFESSIONAL SERVICES LLC
Entity type:Organization
Organization Name:ADESSO PROFESSIONAL SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:MAYNOLDI
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:904-579-4766
Mailing Address - Street 1:5000-18 US HWY 17 S
Mailing Address - Street 2:# 241
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003
Mailing Address - Country:US
Mailing Address - Phone:877-228-1221
Mailing Address - Fax:877-842-4020
Practice Address - Street 1:1202 KINGSLEY AVE
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4632
Practice Address - Country:US
Practice Address - Phone:877-228-1221
Practice Address - Fax:877-842-4020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-14
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME130811207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME130811OtherDAVID MAYNOLDI'S FL MED LIC
FL1144591249OtherDAVID MAYNOLDI MD NPI #