Provider Demographics
NPI:1326032061
Name:GIRALDO, KENNETH ALEJANDRO (MD,PA)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:ALEJANDRO
Last Name:GIRALDO
Suffix:
Gender:M
Credentials:MD,PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5831 BEE RIDGE RD
Mailing Address - Street 2:STE 100
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-5088
Mailing Address - Country:US
Mailing Address - Phone:941-343-1040
Mailing Address - Fax:941-343-1042
Practice Address - Street 1:1219 S EAST AVE
Practice Address - Street 2:STE 101
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2340
Practice Address - Country:US
Practice Address - Phone:941-364-2272
Practice Address - Fax:941-954-4375
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2016-10-04
Deactivation Date:2006-03-25
Deactivation Code:
Reactivation Date:2006-04-13
Provider Licenses
StateLicense IDTaxonomies
FLME71677174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF93045OtherUPIN
FLK4072Medicare ID - Type UnspecifiedPROVIDER ID