Healthcare Provider Details

I. General information

NPI: 1588819155
Provider Name (Legal Business Name): ALL PEDIATRICS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2008
Last Update Date: 11/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 WINDGUARD CIR STE 102
WESLEY CHAPEL FL
33544-7353
US

IV. Provider business mailing address

2615 WINDGUARD CIR STE 102
WESLEY CHAPEL FL
33544-7353
US

V. Phone/Fax

Practice location:
  • Phone: 813-333-9991
  • Fax: 813-466-7482
Mailing address:
  • Phone: 813-333-9991
  • Fax: 813-466-7482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME94439
License Number StateFL

VIII. Authorized Official

Name: DR. SIVA PRASANNA DEVANABOYENA
Title or Position: PRESIDENT
Credential:
Phone: 813-333-9991