Provider Demographics
NPI:1326058488
Name:AGAZZI, SIVIERO (MD)
Entity Type:Individual
Prefix:
First Name:SIVIERO
Middle Name:
Last Name:AGAZZI
Suffix:
Gender:M
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:PO BOX 917770
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2 TAMPA GENERAL CIR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3603
Practice Address - Country:US
Practice Address - Phone:813-259-0890
Practice Address - Fax:813-259-0628
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME95184207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL28630OtherBLUE CROSS BLUE SHIELD
FL273269600Medicaid
FL28630OtherBLUE CROSS BLUE SHIELD
FLU5483ZMedicare PIN
FL020009249Medicare PIN