Healthcare Provider Details

I. General information

NPI: 1285540799
Provider Name (Legal Business Name): STARYA LONG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1944 N HERCULES AVE
CLEARWATER FL
33763-4403
US

IV. Provider business mailing address

6225 PADDOCK GLEN DR UNIT 311
TAMPA FL
33634-5373
US

V. Phone/Fax

Practice location:
  • Phone: 727-797-8100
  • Fax:
Mailing address:
  • Phone: 727-797-8100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberPT45320
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: