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General NPI Number Information
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NPI Number | 1720334493
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Entity Type | Individual
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Provider Name | PETER THOMAS SCULLY M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/31/2012
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Last Update Date | 04/10/2024
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Provider Practice Location Address
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Address Line | 501 6TH AVE S
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City | SAINT PETERSBURG
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State | FL
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Zip | 33701-4634
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Country | US
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Telephone | 727-767-4343
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Fax |
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Provider Business Mailing Address
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Address Line | 501 6TH AVE S STE 1.134
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City | SAINT PETERSBURG
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State | FL
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Zip | 33701-4634
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Country | US
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Telephone | 727-767-8346
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | S1704
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | S1704
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 2080P0203X
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Taxonomy Name | Pediatric Critical Care Medicine Physician
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License Number | S1704
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 2080P0203X
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Taxonomy Name | Pediatric Critical Care Medicine Physician
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License Number | ME161982
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License Number State | FL
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