MEDICARE: DR. LISA ANN FLAHERTY 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	2084N0400X	Neurology Physician	OS9216	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	43183Y	OTHER	FL	MEDICARE PTAN

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	:	1386607315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA ANN FLAHERTY DO

Provider Business Mailing Address
First Line	:	5880 49TH ST N
Second Line	:	SUITE 104
City	:	ST PETERSBURG
State	:	FL
Zip	:	33709-2150
Country	:	US
Telephone Number	:	727-528-6100
Fax Number	:	727-528-7895

Provider Business Practice Location Address
First Line	:	5880 49TH ST N
Second Line	:	SUITE 104
City	:	ST PETERSBURG
State	:	FL
Zip	:	33709-2150
Country	:	US
Telephone Number	:	727-528-6100
Fax Number	:	727-528-7895

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

Provider Enumeration Date	:	04/10/2006
Last Update Date	:	03/17/2018

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Directions to “ DR. LISA ANN FLAHERTY DO” Practice Location

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