Healthcare Provider Details

I. General information

NPI: 1770534802
Provider Name (Legal Business Name): JENNIFER ROOT MAYER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2006
Last Update Date: 05/03/2022
Certification Date: 05/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 6TH AVE S DEPT 6941
ST PETERSBURG FL
33701-4634
US

IV. Provider business mailing address

501 6TH AVE S DEPT 6941
ST PETERSBURG FL
33701-4634
US

V. Phone/Fax

Practice location:
  • Phone: 727-767-4429
  • Fax: 727-767-4970
Mailing address:
  • Phone: 727-767-4429
  • Fax: 727-767-4970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME68106
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License NumberME68106
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: