Healthcare Provider Details

I. General information

NPI: 1821522830
Provider Name (Legal Business Name): NICKLAS CARY OROBELLO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: NICK CARY OROBELLO M.D.

II. Dates (important events)

Enumeration Date: 04/17/2017
Last Update Date: 04/20/2023
Certification Date: 04/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8950 DR MLK JR STREET N SUITE 150
ST. PETERSBURG FL
33702
US

IV. Provider business mailing address

8950 DR MLK JR STREET N SUITE 150
ST. PETERSBURG FL
33702
US

V. Phone/Fax

Practice location:
  • Phone: 727-329-5400
  • Fax:
Mailing address:
  • Phone: 727-329-5400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number210002132
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: