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NPI Code Detail

MEDICARE: PEDIATRIC ASSOCIATES OF TAMPA BAY, LLC

MEDICARE: PEDIATRIC ASSOCIATES OF TAMPA BAY, LLC
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
1208000000XPediatrics Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1912345497
Entity Type Code : Organization
Provider Name (Legal Business Name) : PEDIATRIC ASSOCIATES OF TAMPA BAY, LLC
Provider Business Mailing Address
First Line : 900 S PINE ISLAND RD
Second Line : 800
City : PLANTATION
State : FL
Zip : 33324-3920
Country : US
Telephone Number : 954-967-6400
Fax Number : 954-965-7339
Provider Business Practice Location Address
First Line : 10710 STATE ROAD 54 STE 108
Second Line :
City : TRINITY
State : FL
Zip : 34655-2263
Country : US
Telephone Number : 727-376-4040
Fax Number : 727-376-8824
Authorized Official
Title or Position : CEO
Name : DR. PETER J SHULMAN
Credential : MD
Telephone Number : 954-965-7322
Provider Enumeration Date : 06/06/2013
Last Update Date : 08/25/2020

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1215908082 — GRACIELA F EGLI M.D.
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1669771028 — ALISHA FAYE PINEIRO D.O.
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Directions to “PEDIATRIC ASSOCIATES OF TAMPA BAY, LLC ” Practice Location

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