MEDICARE: PEDIATRICS OF ST. AUGUSTINE

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	208000000X	Pediatrics Physician	ME87309	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	:	1457565947
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDIATRICS OF ST. AUGUSTINE

Provider Business Mailing Address
First Line	:	2676 US HIGHWAY 1 S
Second Line	:
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32086-6191
Country	:	US
Telephone Number	:	904-797-2121
Fax Number	:

Provider Business Practice Location Address
First Line	:	2676 US HIGHWAY 1 S
Second Line	:
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32086-6191
Country	:	US
Telephone Number	:	904-797-2121
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ALIYA M YASIN
Credential	:	MD
Telephone Number	:	904-797-2121

Provider Enumeration Date	:	05/10/2007
Last Update Date	:	07/12/2007

Similar Medicare Providers

1487644373 — MARGARET E ROBINSON OT
Practice Location Address:

2630 US 1 S
SAINT AUGUSTINE, FL
32086-6191

Practice Phone: 904-829-3411
Practice Fax: 904-829-3412

1841266061 — ALIYA YASIN MD
Practice Location Address:

2676 US HIGHWAY 1 S
ST AUGUSTINE, FL
32086-6191

Practice Phone: 904-797-2121
Practice Fax: 904-797-2120

1568479269 — MR. JAMES ALAN VITI PT
Practice Location Address:

2630 US 1 S
SAINT AUGUSTINE, FL
32086-6191

Practice Phone: 904-829-3411
Practice Fax:

1003823709 — FIRST COAST PHYSICAL THERAPY INC
Practice Location Address:

2630 US 1 S
ST AUGUSTINE, FL
32086-6191

Practice Phone: 904-829-3411
Practice Fax:

1083751093 — AMANDA KAY GRIENER MPT
Practice Location Address:

2630 US 1 S
ST AUGUSTINE, FL
32086-6191

Practice Phone: 904-829-3411
Practice Fax: 904-829-3412

1124367073 — DR. BRYAN DANIEL OLSON PT, DPT
Practice Location Address:

2630 US 1 S
ST AUGUSTINE, FL
32086-6191

Practice Phone: 904-829-3411
Practice Fax: 904-829-3412

Directions to “PEDIATRICS OF ST. AUGUSTINE ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.