Healthcare Provider Details

I. General information

NPI: 1003420308
Provider Name (Legal Business Name): NEKO GUDE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2020
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11522 US HIGHWAY 19 BLDG B
PORT RICHEY FL
34668-1431
US

IV. Provider business mailing address

11528 US HIGHWAY 19
PORT RICHEY FL
34668-1442
US

V. Phone/Fax

Practice location:
  • Phone: 727-868-2151
  • Fax:
Mailing address:
  • Phone: 727-868-2151
  • Fax: 727-869-0732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9112768
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: