MEDICARE: AMANDA BROOKE SERGAY MD

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	207N00000X	Dermatology Physician	ME114062	FL

General Provider Information

NPI Number	:	1730362112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA BROOKE SERGAY MD

Provider Business Mailing Address
First Line	:	3216 W AZEELE ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-3018
Country	:	US
Telephone Number	:	917-309-3019
Fax Number	:	813-738-5661

Provider Business Practice Location Address
First Line	:	3216 W AZEELE ST STE 1
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-3018
Country	:	US
Telephone Number	:	813-738-5660
Fax Number	:	813-738-5661

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

Provider Enumeration Date	:	12/09/2007
Last Update Date	:	11/06/2023

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