Provider Demographics
NPI:1629208509
Name:SVETA MEDICAL PLLC
Entity Type:Organization
Organization Name:SVETA MEDICAL PLLC
Other - Org Name:BLOSSOM PEDIATRIC CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DURGA
Authorized Official - Middle Name:P
Authorized Official - Last Name:CHINTAKAYALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-324-7029
Mailing Address - Street 1:3301 BAYSHORE BLVD UNIT 2207B
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-8840
Mailing Address - Country:US
Mailing Address - Phone:718-483-2934
Mailing Address - Fax:
Practice Address - Street 1:507 E DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:112
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-3932
Practice Address - Country:US
Practice Address - Phone:813-229-6139
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-25
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X, 208000000X
FLME112476261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014416300Medicaid
NY456160000OtherPRI
NY02625189Medicaid
NY02625189Medicaid