MEDICARE: PENNY PEDIATRICS, INC., 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	ME0074526	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

General Provider Information

NPI Number	:	1760646848
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PENNY PEDIATRICS, INC., P.A.

Provider Business Mailing Address
First Line	:	14430 US HIGHWAY 1
Second Line	:	SUITE 101
City	:	SEBASTIAN
State	:	FL
Zip	:	32958-3289
Country	:	US
Telephone Number	:	772-581-0300
Fax Number	:	772-581-0010

Provider Business Practice Location Address
First Line	:	14430 US HIGHWAY 1
Second Line	:	SUITE 101
City	:	SEBASTIAN
State	:	FL
Zip	:	32958-3289
Country	:	US
Telephone Number	:	772-581-0300
Fax Number	:	772-581-0010

Authorized Official
Title or Position	:	PRES., SEC., TREAS., DIRECTOR
Name	:	DR. MARZA PENNY
Credential	:	M.D.
Telephone Number	:	772-581-0300

Provider Enumeration Date	:	07/17/2008
Last Update Date	:	07/17/2008

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Directions to “PENNY PEDIATRICS, INC., P.A. ” Practice Location

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