MEDICARE: MY CHOICE PRIMARY CARE, PLLC

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	261QM2500X	Medical Specialty Clinic/Center

General Provider Information

NPI Number	:	1568323145
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MY CHOICE PRIMARY CARE, PLLC

Provider Business Mailing Address
First Line	:	2623 MCCORMICK DR STE 104
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33759-1046
Country	:	US
Telephone Number	:	727-607-0504
Fax Number	:	833-760-4065

Provider Business Practice Location Address
First Line	:	2623 MCCORMICK DR STE 104
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33759-1046
Country	:	US
Telephone Number	:	727-607-0504
Fax Number	:	833-760-4065

Authorized Official
Title or Position	:	FOUNDER
Name	:	DR. TEERESA SISODIA
Credential	:	MD
Telephone Number	:	843-725-9193

Provider Enumeration Date	:	11/21/2025
Last Update Date	:	12/05/2025

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