MEDICARE: SARDHA M PERERA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208VP0014X	Interventional Pain Medicine Physician	ME83234	FL
2	207LP2900X	Pain Medicine (Anesthesiology) Physician	ME83234	FL
3	207L00000X	Anesthesiology Physician	ME83234	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	13417	OTHER	WELLCARE
2	78636	OTHER	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114995552
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARDHA M PERERA MD

Provider Business Mailing Address
First Line	:	6333 54TH AVE N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33709-1703
Country	:	US
Telephone Number	:	727-548-6100
Fax Number	:	727-545-0960

Provider Business Practice Location Address
First Line	:	6333 54TH AVE N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33709-1703
Country	:	US
Telephone Number	:	727-548-6100
Fax Number	:	727-545-0960

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2006
Last Update Date	:	09/18/2015

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Directions to “ SARDHA M PERERA MD” Practice Location

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