Healthcare Provider Details

I. General information

NPI: 1558455568
Provider Name (Legal Business Name): PAUL ANTHONY PIETRO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 09/27/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1828 AYNSLEY WAY APT 2
VERO BEACH FL
32966-8061
US

IV. Provider business mailing address

1828 AYNSLEY WAY APT 2
VERO BEACH FL
32966-8061
US

V. Phone/Fax

Practice location:
  • Phone: 803-207-9919
  • Fax:
Mailing address:
  • Phone: 803-207-9919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number31479
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License NumberME0059300
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberME0059300
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number74743
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: