Healthcare Provider Details

I. General information

NPI: 1629606876
Provider Name (Legal Business Name): KIMBERLEE PERSAUD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLEE RODRIGUEZ BONILLA MD

II. Dates (important events)

Enumeration Date: 03/31/2020
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7550 43RD ST N
PINELLAS PARK FL
33781-3601
US

IV. Provider business mailing address

7550 43RD ST N
PINELLAS PARK FL
33781-3601
US

V. Phone/Fax

Practice location:
  • Phone: 727-863-5474
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2023-01064
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: