Healthcare Provider Details

I. General information

NPI: 1285678227
Provider Name (Legal Business Name): RHODERICK JAMES MANHATTAN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: RHODNEY JAMES SERVEY PA-C

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 05/26/2023
Certification Date: 05/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2191 9TH AVE N STE 150
ST PETERSBURG FL
33713-7146
US

IV. Provider business mailing address

7901 4TH ST N STE 10810
ST PETERSBURG FL
33702-4305
US

V. Phone/Fax

Practice location:
  • Phone: 888-958-5343
  • Fax: 888-958-5343
Mailing address:
  • Phone: 888-958-5343
  • Fax: 888-958-5343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number6023642
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA10004997
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number14837
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9111321
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: