Provider Demographics
NPI:1285678227
Name:MANHATTAN, RHODERICK JAMES (PA-C)
Entity Type:Individual
Prefix:
First Name:RHODERICK
Middle Name:JAMES
Last Name:MANHATTAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:RHODNEY
Other - Middle Name:JAMES
Other - Last Name:SERVEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:7901 4TH ST N STE 10810
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-4305
Mailing Address - Country:US
Mailing Address - Phone:888-958-5343
Mailing Address - Fax:888-958-5343
Practice Address - Street 1:2191 9TH AVE N STE 150
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-7146
Practice Address - Country:US
Practice Address - Phone:888-958-5343
Practice Address - Fax:888-958-5343
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6023642207Q00000X
WAPA10004997363A00000X
NY14837363A00000X
FLPA9111321363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7671688OtherCIGNA
FL112430800Medicaid
FL11736349OtherCAHQ