Healthcare Provider Details

I. General information

NPI: 1093024333
Provider Name (Legal Business Name): CARDIOTHORACIC SURGERY OF HYDE PARK INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2010
Last Update Date: 03/08/2021
Certification Date: 03/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8950 9TH ST N STE 102
ST PETERSBURG FL
33702-3001
US

IV. Provider business mailing address

301 W PLATT ST SUITE 24
TAMPA FL
33606-2292
US

V. Phone/Fax

Practice location:
  • Phone: 727-498-8898
  • Fax: 727-800-6959
Mailing address:
  • Phone: 727-498-8898
  • Fax: 727-800-6959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LEAH TEEKELL-TAYLOR
Title or Position: OWNER/PROVIDER
Credential:
Phone: 727-498-8898