Provider Demographics
NPI:1548547524
Name:FLORIDA PEDIATRICS PA
Entity type:Organization
Organization Name:FLORIDA PEDIATRICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SILVIA
Authorized Official - Middle Name:VELHO
Authorized Official - Last Name:YANG
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:321-633-9973
Mailing Address - Street 1:980 BREVARD AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-2141
Mailing Address - Country:US
Mailing Address - Phone:321-633-9973
Mailing Address - Fax:321-633-3120
Practice Address - Street 1:980 BREVARD AVE
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-2141
Practice Address - Country:US
Practice Address - Phone:321-633-9973
Practice Address - Fax:321-633-3120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-04
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME70850261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care