MEDICARE: AMIE BETH GERODIMOS DO

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	2084P0804X	Child & Adolescent Psychiatry Physician	OS-22472	FL
2	2084F0202X	Forensic Psychiatry Physician	OS-22472	FL
3	2084P0800X	Psychiatry Physician	OS-22472	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
2	LEOIZ	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1346700051
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMIE BETH GERODIMOS DO

Provider Business Mailing Address
First Line	:	PO BOX 917770
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32891-0001
Country	:	US
Telephone Number	:	813-821-8038
Fax Number	:

Provider Business Practice Location Address
First Line	:	1303 W KENNEDY BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33606-1848
Country	:	US
Telephone Number	:	813-893-6330
Fax Number	:

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

Provider Enumeration Date	:	03/20/2019
Last Update Date	:	11/13/2025

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