Healthcare Provider Details

I. General information

NPI: 1447697099
Provider Name (Legal Business Name): SHARI TASHA ANTHONY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2013
Last Update Date: 06/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8730 4TH ST N
ST PETERSBURG FL
33702-3106
US

IV. Provider business mailing address

8730 4TH ST N
ST PETERSBURG FL
33702-3106
US

V. Phone/Fax

Practice location:
  • Phone: 727-577-9700
  • Fax:
Mailing address:
  • Phone: 727-577-9700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number18889
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: