Provider Demographics
NPI:1356639512
Name:ST. PETE ENDOCRINOLOGY ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:ST. PETE ENDOCRINOLOGY ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:SRIKANTH
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMACHANDRUNI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-917-5188
Mailing Address - Street 1:PO BOX 560361
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32956-0361
Mailing Address - Country:US
Mailing Address - Phone:321-917-5188
Mailing Address - Fax:321-504-9710
Practice Address - Street 1:2025 MURRELL RD
Practice Address - Street 2:SUITE 170
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-3624
Practice Address - Country:US
Practice Address - Phone:321-917-5188
Practice Address - Fax:321-504-9710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-21
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82867207R00000X
FLME108425207RE0101X
FLME108742207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH49519Medicare UPIN