Healthcare Provider Details

I. General information

NPI: 1003217183
Provider Name (Legal Business Name): PEDIATRICS AT RIVER'S EDGE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2014
Last Update Date: 12/30/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9948 GROVE DR
NEW PORT RICHEY FL
34654-3403
US

IV. Provider business mailing address

9948 GROVE DR
NEW PORT RICHEY FL
34654-3403
US

V. Phone/Fax

Practice location:
  • Phone: 727-844-3551
  • Fax: 727-847-0427
Mailing address:
  • Phone: 727-844-3551
  • Fax: 727-847-0427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number3078370
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number1881067460
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ALDO C DONDERO
Title or Position: PRESIDENT
Credential: MD
Phone: 727-844-3551