Healthcare Provider Details

I. General information

NPI: 1366715799
Provider Name (Legal Business Name): FRANK WILLIAM AYESTARAN CASSANI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2012
Last Update Date: 10/27/2020
Certification Date: 10/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 DAVIS BLVD STE 200
TAMPA FL
33606-3438
US

IV. Provider business mailing address

PO BOX 917770
ORLANDO FL
32891-0001
US

V. Phone/Fax

Practice location:
  • Phone: 823-259-8760
  • Fax:
Mailing address:
  • Phone: 813-974-2201
  • Fax: 813-974-2812

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 Code2080P0210X
TaxonomyPediatric Nephrology Physician
License NumberME123243
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: