Healthcare Provider Details

I. General information

NPI: 1275578510
Provider Name (Legal Business Name): HAYNES MILAS STERLING PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 12/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1395 W BAY DR
LARGO FL
33770
US

IV. Provider business mailing address

1395 W BAY DR
LARGO FL
33770
US

V. Phone/Fax

Practice location:
  • Phone: 727-584-6802
  • Fax: 727-586-6278
Mailing address:
  • Phone: 727-584-6802
  • Fax: 727-586-6278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier062649000
Identifier TypeMEDICAID
Identifier StateFL
Identifier Issuer

VIII. Authorized Official

Name: AUDREY JOHNSON-MILAS
Title or Position: PEDIATRICIAN PARTNER
Credential: DO
Phone: 727-584-6802