Healthcare Provider Details

I. General information

NPI: 1245477868
Provider Name (Legal Business Name): J. PAONESSA M.D. P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2009
Last Update Date: 05/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 S PARSONS AVE SUITE 101
BRANDON FL
33511-5289
US

IV. Provider business mailing address

1201 5TH AVE N SUITE 505
ST PETERSBURG FL
33705-1455
US

V. Phone/Fax

Practice location:
  • Phone: 813-982-3460
  • Fax: 813-982-3461
Mailing address:
  • Phone: 727-821-0017
  • Fax: 727-502-8860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: RYAN CIARROCCHI
Title or Position: CFO
Credential:
Phone: 727-824-4601