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General NPI Number Information
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NPI Number | 1801674510
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Entity Type | Organization
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Legal Business Name | SKANDY SPINE & SPECIALISTS LLC
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Dates
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Enumeration Date | 09/15/2023
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Last Update Date | 09/15/2023
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Provider Practice Location Address
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Address Line | 3491 GANDY BLVD N STE 205
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City | PINELLAS PARK
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State | FL
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Zip | 33781-2654
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Country | US
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Telephone | 727-623-9402
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Fax | 727-623-9406
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Provider Business Mailing Address
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Address Line | 3491 GANDY BLVD N STE 205
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City | PINELLAS PARK
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State | FL
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Zip | 33781-2654
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Country | US
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Telephone | 727-623-9402
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Fax | 727-623-9406
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Authorized Official
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Title or Position | OWNER
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Name | THEOPHILOS SKANDALIARIS
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Credential |
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Telephone | 727-623-9402
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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