Healthcare Provider Details

I. General information

NPI: 1497308803
Provider Name (Legal Business Name): CHRISTOPHER GEORGE DASTOUS PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2019
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 MORTON PLANT ST STE 301
CLEARWATER FL
33756-3395
US

IV. Provider business mailing address

13020 N TELECOM PKWY
TEMPLE TERRACE FL
33637-0925
US

V. Phone/Fax

Practice location:
  • Phone: 727-461-6026
  • Fax: 727-461-1492
Mailing address:
  • Phone: 813-978-9700
  • Fax: 813-558-6494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number6408
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number7470
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number6408
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: