MEDICARE: NEKO GUDE PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA9112768	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003420308
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NEKO GUDE PA

Provider Business Mailing Address
First Line	:	11528 US HIGHWAY 19
Second Line	:
City	:	PORT RICHEY
State	:	FL
Zip	:	34668-1442
Country	:	US
Telephone Number	:	727-868-2151
Fax Number	:	727-869-0732

Provider Business Practice Location Address
First Line	:	11522 US HIGHWAY 19 BLDG B
Second Line	:
City	:	PORT RICHEY
State	:	FL
Zip	:	34668-1431
Country	:	US
Telephone Number	:	727-868-2151
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/03/2020
Last Update Date	:	05/14/2025

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Directions to “ NEKO GUDE PA” Practice Location

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