Healthcare Provider Details

I. General information

NPI: 1699789255
Provider Name (Legal Business Name): AUDREY ZELICOF PAUL MD PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AUDREY ZELICOF MD

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1822 DREW ST STE 101
CLEARWATER FL
33765-2921
US

IV. Provider business mailing address

1822 DREW ST STE 101
CLEARWATER FL
33765-2921
US

V. Phone/Fax

Practice location:
  • Phone: 727-303-3117
  • Fax: 727-335-4430
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME151077
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME151077
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number211312
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: