Healthcare Provider Details

I. General information

NPI: 1609290477
Provider Name (Legal Business Name): PEDIATRIC ASSOCIATES OF NORTHEAST FLORIDA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2014
Last Update Date: 08/25/2020
Certification Date: 08/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 S PINE ISLAND RD SUITE 800
PLANTATION FL
33324-3920
US

IV. Provider business mailing address

900 S PINE ISLAND RD SUITE 800
PLANTATION FL
33324-3920
US

V. Phone/Fax

Practice location:
  • Phone: 954-967-6400
  • Fax: 954-965-7339
Mailing address:
  • Phone: 954-967-6400
  • Fax: 954-965-7339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. PETER J SHULMAN
Title or Position: CEO
Credential: MD
Phone: 954-967-6400