Provider Demographics
NPI:1588819155
Name:ALL PEDIATRICS, P.A.
Entity Type:Organization
Organization Name:ALL PEDIATRICS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SIVA
Authorized Official - Middle Name:PRASANNA
Authorized Official - Last Name:DEVANABOYENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-333-9991
Mailing Address - Street 1:2615 WINDGUARD CIR
Mailing Address - Street 2:STE 102
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-7353
Mailing Address - Country:US
Mailing Address - Phone:813-333-9991
Mailing Address - Fax:813-466-7482
Practice Address - Street 1:2615 WINDGUARD CIR
Practice Address - Street 2:STE 102
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-7353
Practice Address - Country:US
Practice Address - Phone:813-333-9991
Practice Address - Fax:813-466-7482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-24
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME94439208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2741442300Medicaid
1518988823OtherSIVA P DEVANABOYENA INDIVIDUAL NPI