Healthcare Provider Details

I. General information

NPI: 1063656312
Provider Name (Legal Business Name): ERICA K SCHALLERT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERICA AUDREY KINARD M.D.

II. Dates (important events)

Enumeration Date: 04/29/2009
Last Update Date: 03/10/2022
Certification Date: 03/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 727-767-3318
  • Fax:
Mailing address:
  • Phone: 727-767-3318
  • Fax: 727-767-8002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License NumberTRN13824
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberQ0358
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: