Provider Demographics
NPI:1548257827
Name:TUNANIDAS PANTELIS, AMELIA G (DO)
Entity type:Individual
Prefix:DR
First Name:AMELIA
Middle Name:G
Last Name:TUNANIDAS PANTELIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:AMELIA
Other - Middle Name:G
Other - Last Name:TUNANIDAS NEUENDORF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:2717 SEVILLE BLVD
Mailing Address - Street 2:#2307
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33764-1163
Mailing Address - Country:US
Mailing Address - Phone:727-796-4608
Mailing Address - Fax:727-796-4608
Practice Address - Street 1:5100 W KENNEDY BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-1849
Practice Address - Country:US
Practice Address - Phone:813-262-9500
Practice Address - Fax:813-262-9442
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-3535N207Q00000X
FLOS8964207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2084588Medicaid
A80745Medicare UPIN
OH2084588Medicaid