MEDICARE: PODIATRY NURSING HOME ASSOCIATES

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	213EP1101X	Primary Podiatric Medicine Podiatrist

General Provider Information

NPI Number	:	1487336483
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PODIATRY NURSING HOME ASSOCIATES

Provider Business Mailing Address
First Line	:	4144 N ARMENIA AVE STE 230
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-6447
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4144 N ARMENIA AVE STE 230
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-6447
Country	:	US
Telephone Number	:	813-872-8939
Fax Number	:	813-872-8649

Authorized Official
Title or Position	:	OWNER
Name	:	DR. PAUL L SHEEHY JR.
Credential	:	DPM
Telephone Number	:	813-872-8939

Provider Enumeration Date	:	08/01/2023
Last Update Date	:	08/01/2023

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