Healthcare Provider Details

I. General information

NPI: 1205079407
Provider Name (Legal Business Name): JANE PARK SANDO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JANE HEE PARK M.D.

II. Dates (important events)

Enumeration Date: 04/17/2009
Last Update Date: 09/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 5TH ST S ALL CHILDREN'S SPECIALTY PHYSICIANS
ST PETERSBURG FL
33701-4804
US

IV. Provider business mailing address

601 5TH ST S ALL CHILDREN'S SPECIALTY PHYSICIANS
ST PETERSBURG FL
33701-4804
US

V. Phone/Fax

Practice location:
  • Phone: 727-767-3051
  • Fax: 727-767-4970
Mailing address:
  • Phone: 727-767-3051
  • Fax: 727-767-4970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberD73945
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA130695
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME124323
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: