MEDICARE: ALL PEDIATRICS, P.A.

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	208000000X	Pediatrics Physician	ME94439	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1518988823	OTHER		SIVA P DEVANABOYENA INDIVIDUAL NPI

General Provider Information

NPI Number	:	1588819155
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALL PEDIATRICS, P.A.

Provider Business Mailing Address
First Line	:	2615 WINDGUARD CIR
Second Line	:	STE 102
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33544-7353
Country	:	US
Telephone Number	:	813-333-9991
Fax Number	:	813-466-7482

Provider Business Practice Location Address
First Line	:	2615 WINDGUARD CIR
Second Line	:	STE 102
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33544-7353
Country	:	US
Telephone Number	:	813-333-9991
Fax Number	:	813-466-7482

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SIVA PRASANNA DEVANABOYENA
Credential	:
Telephone Number	:	813-333-9991

Provider Enumeration Date	:	11/24/2008
Last Update Date	:	11/24/2008

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