Provider Demographics
NPI:1710350178
Name:STRYJEWSKI, ERIC
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:STRYJEWSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10326 PALERMO CIR APT 304
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-5110
Mailing Address - Country:US
Mailing Address - Phone:813-631-1547
Mailing Address - Fax:
Practice Address - Street 1:19034 BRUCE B DOWNS BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-2434
Practice Address - Country:US
Practice Address - Phone:813-631-1547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-06
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPSI 31376390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program