Healthcare Provider Details

I. General information

NPI: 1255312666
Provider Name (Legal Business Name): FIFTH AVENUE PEDIATRICS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2005
Last Update Date: 03/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2855 5TH AVE N
ST PETERSBURG FL
33713-6701
US

IV. Provider business mailing address

2855 5TH AVE N
ST PETERSBURG FL
33713-6701
US

V. Phone/Fax

Practice location:
  • Phone: 727-323-2727
  • Fax: 727-327-8101
Mailing address:
  • Phone: 727-323-2727
  • Fax: 727-327-8101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: PAMELA M PATRANELLA
Title or Position: PRESIDENT
Credential: MD
Phone: 727-323-2727