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General NPI Number Information
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NPI Number | 1174173421
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Entity Type | Organization
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Legal Business Name | PINELLAS VASCULAR LLC
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Dates
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Enumeration Date | 09/18/2019
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Last Update Date | 09/24/2024
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Provider Practice Location Address
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Address Line | 5880 49TH ST N STE 206
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City | ST PETERSBURG
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State | FL
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Zip | 33709-2147
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Country | US
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Telephone | 813-997-2099
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Fax |
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Provider Business Mailing Address
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Address Line | 5260 78TH AVE N # 2776
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City | PINELLAS PARK
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State | FL
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Zip | 33781-2347
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Country | US
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Telephone | 727-999-8346
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Fax | 877-743-4465
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Authorized Official
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Title or Position | OWNER/ PHYSICIAN
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Name | AVIANNE BUNNELL
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Credential | MD
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Telephone | 727-999-8346
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number |
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License Number State |
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