1588819155 NPI number — ALL PEDIATRICS, P.A.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588819155 NPI number — ALL PEDIATRICS, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALL PEDIATRICS, P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588819155
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2615 WINDGUARD CIR
Provider Second Line Business Mailing Address:
STE 102
Provider Business Mailing Address City Name:
WESLEY CHAPEL
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33544-7353
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-333-9991
Provider Business Mailing Address Fax Number:
813-466-7482

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2615 WINDGUARD CIR
Provider Second Line Business Practice Location Address:
STE 102
Provider Business Practice Location Address City Name:
WESLEY CHAPEL
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33544-7353
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-333-9991
Provider Business Practice Location Address Fax Number:
813-466-7482
Provider Enumeration Date:
11/24/2008

Additional Information

Authorized Official

Authorized Official Last Name:
DEVANABOYENA
Authorized Official First Name:
SIVA
Authorized Official Middle Name:
PRASANNA
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
813-333-9991

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  ME94439 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2741442300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1518988823 . This is a "SIVA P DEVANABOYENA INDIVIDUAL NPI" identifier . This identifiers is of the category "OTHER".




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