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General NPI Number Information
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NPI Number | 1205192739
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Entity Type | Organization
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Legal Business Name | ANASTASIA PEDIATRICS
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Dates
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Enumeration Date | 04/10/2012
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Last Update Date | 04/30/2013
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Provider Practice Location Address
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Address Line | 100 WHETSTONE PL SUITE 205
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-5774
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Country | US
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Telephone | 904-819-9925
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Fax | 904-819-9926
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Provider Business Mailing Address
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Address Line | 100 WHETSTONE PL SUITE 205
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-5774
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Country | US
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Telephone | 904-819-9925
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Fax | 904-819-9926
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Authorized Official
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Title or Position | DOCTOR
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Name | MONALI MANIKAL
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Credential | MD
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Telephone | 904-819-9925
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | ME0081118
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License Number State | FL
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