Healthcare Provider Details

I. General information

NPI: 1295112175
Provider Name (Legal Business Name): COLLEEN MARIE SABELLA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2015
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3645 MADACA LN
TAMPA FL
33618-2048
US

IV. Provider business mailing address

3645 MADACA LN
TAMPA FL
33618-2048
US

V. Phone/Fax

Practice location:
  • Phone: 503-494-4300
  • Fax: 503-494-4323
Mailing address:
  • Phone: 813-969-0116
  • Fax: 813-969-3794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD199260
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberMD199260
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: