Healthcare Provider Details

I. General information

NPI: 1528640976
Provider Name (Legal Business Name): PETERSON SAINT CYR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2021
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4807 US HIGHWAY 19 STE 102
NEW PORT RICHEY FL
34652-4260
US

IV. Provider business mailing address

13346 CANOPY GROVE DR APT 304
TAMPA FL
33625-4033
US

V. Phone/Fax

Practice location:
  • Phone: 727-846-7618
  • Fax: 727-849-7090
Mailing address:
  • Phone: 727-846-7618
  • Fax: 727-849-7090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberME182569
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: