Provider Demographics
NPI:1689787160
Name:TAMPA BAY PODIATRY ASSOCIATESPA
Entity Type:Organization
Organization Name:TAMPA BAY PODIATRY ASSOCIATESPA
Other - Org Name:TAMPA OFFICE FOR TAMPA BAY PODIATRY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:IRA
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:SHANDLES
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:813-960-0115
Mailing Address - Street 1:PO BOX 271490
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33688-1490
Mailing Address - Country:US
Mailing Address - Phone:813-960-0115
Mailing Address - Fax:813-254-9192
Practice Address - Street 1:14310 N DALE MABRY HWY STE 180
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-2059
Practice Address - Country:US
Practice Address - Phone:813-960-0115
Practice Address - Fax:813-254-9192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatricGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL87772Medicare PIN