Provider Demographics
NPI:1730878612
Name:BIODYNAMIC HEALTH
Entity type:Organization
Organization Name:BIODYNAMIC HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:PETRONELLI
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:401-481-9361
Mailing Address - Street 1:5440 8TH AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-6512
Mailing Address - Country:US
Mailing Address - Phone:401-481-9361
Mailing Address - Fax:
Practice Address - Street 1:1150 19TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-5739
Practice Address - Country:US
Practice Address - Phone:401-481-9361
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-05
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty