Healthcare Provider Details

I. General information

NPI: 1518926690
Provider Name (Legal Business Name): ANTHONY ANDREW PERSZYK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2006
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 A1A N STE 101
PONTE VEDRA BEACH FL
32082-4071
US

IV. Provider business mailing address

112 BARTRAM OAKS WALK UNIT 600849
SAINT JOHNS FL
32260-7734
US

V. Phone/Fax

Practice location:
  • Phone: 904-673-0044
  • Fax: 904-673-1064
Mailing address:
  • Phone: 904-673-0044
  • Fax: 904-673-1064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License NumberME64460
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME64460
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD492023C
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number207SG0201X
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: