Healthcare Provider Details

I. General information

NPI: 1427432590
Provider Name (Legal Business Name): TOTS & TEENS PEDIATRICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2015
Last Update Date: 11/17/2022
Certification Date: 11/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

933 BROWN CHAPEL RD
SAINT CLOUD FL
34769-2043
US

IV. Provider business mailing address

933 BROWN CHAPEL RD
SAINT CLOUD FL
34769-2043
US

V. Phone/Fax

Practice location:
  • Phone: 407-593-2883
  • Fax:
Mailing address:
  • Phone: 407-593-2883
  • Fax: 407-593-2884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME105478
License Number StateFL

VIII. Authorized Official

Name: DR. ALAA ELBANNA
Title or Position: MANAGER
Credential: M.D.
Phone: 407-766-8105