Provider Demographics
NPI:1124195797
Name:NARDONE, LIA (MD)
Entity Type:Individual
Prefix:DR
First Name:LIA
Middle Name:
Last Name:NARDONE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 5TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-3015
Mailing Address - Country:US
Mailing Address - Phone:727-820-0505
Mailing Address - Fax:727-820-9707
Practice Address - Street 1:145 5TH AVE NE
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-3015
Practice Address - Country:US
Practice Address - Phone:727-820-0505
Practice Address - Fax:727-820-9707
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL655832084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL25339Medicare ID - Type Unspecified
F83929Medicare UPIN