Healthcare Provider Details

I. General information

NPI: 1669976601
Provider Name (Legal Business Name): PETER JUSTIN ROSSI MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2018
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2647 NARNIA WAY UNIT 101
LAND O LAKES FL
34638-7270
US

IV. Provider business mailing address

4306 W LEONA ST
TAMPA FL
33629-7716
US

V. Phone/Fax

Practice location:
  • Phone: 727-955-4500
  • Fax: 727-955-4550
Mailing address:
  • Phone: 917-985-6790
  • Fax: 727-955-4550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number161586
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number313288
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: