Healthcare Provider Details

I. General information

NPI: 1437688900
Provider Name (Legal Business Name): FADY SOURIAL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2017
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1835 INDIAN ROCKS RD S
LARGO FL
33774-1030
US

IV. Provider business mailing address

1835 INDIAN ROCKS RD S
LARGO FL
33774-1030
US

V. Phone/Fax

Practice location:
  • Phone: 727-586-2273
  • Fax: 727-584-5966
Mailing address:
  • Phone: 727-586-2273
  • Fax: 727-584-5966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberOS23763
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: