{
"Npi": {
"NPI": "1205192739",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ANASTASIA PEDIATRICS",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "100 WHETSTONE PL",
"SecondLineMailingAddress": "SUITE 205",
"MailingAddressCityName": "ST AUGUSTINE",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32086-5774",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "904-819-9925",
"MailingAddressFaxNumber": "904-819-9926",
"FirstLinePracticeLocationAddress": "100 WHETSTONE PL",
"SecondLinePracticeLocationAddress": "SUITE 205",
"PracticeLocationAddressCityName": "ST AUGUSTINE",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "32086-5774",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "904-819-9925",
"PracticeLocationAddressFaxNumber": "904-819-9926",
"EnumerationDate": "04/10/2012",
"LastUpdateDate": "04/30/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": "08/31/2012",
"NPIReactivationDate": "04/30/2013",
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MANIKAL",
"AuthorizedOfficialFirstName": "MONALI",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "DOCTOR",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "904-819-9925",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "208000000X",
"TaxonomyName": "Pediatrics Physician",
"LicenseNumber": "ME0081118",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}