Healthcare Provider Details

I. General information

NPI: 1376284661
Provider Name (Legal Business Name): MATTHEW JOSEPH MESSINA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2022
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 26TH AVE E
BRADENTON FL
34208-7753
US

IV. Provider business mailing address

15932 ELLSWORTH DR
TAMPA FL
33647-1326
US

V. Phone/Fax

Practice location:
  • Phone: 941-782-4600
  • Fax:
Mailing address:
  • Phone: 813-728-3979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberOS21170
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: