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General NPI Number Information
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NPI Number | 1518370345
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Entity Type | Organization
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Legal Business Name | COUNTRYSIDE PEDIATRIC CARE, P.A.
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Dates
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Enumeration Date | 06/10/2014
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Last Update Date | 07/11/2024
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Provider Practice Location Address
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Address Line | 2531 LANDMARK DR STE 103
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City | CLEARWATER
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State | FL
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Zip | 33761-3928
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Country | US
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Telephone | 727-599-0893
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Fax | 727-674-2965
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Provider Business Mailing Address
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Address Line | 2531 LANDMARK DR STE 103
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City | CLEARWATER
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State | FL
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Zip | 33761-3928
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Country | US
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Telephone | 727-599-0893
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Fax | 727-674-2965
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Authorized Official
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Title or Position | PRESIDENT
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Name | MONICA KHARBANDA
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Credential | MD
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Telephone | 727-599-0893
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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 | ME 92529
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License Number State | FL
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