Provider Demographics
NPI:1821522830
Name:OROBELLO, NICKLAS CARY (MD)
Entity Type:Individual
Prefix:
First Name:NICKLAS
Middle Name:CARY
Last Name:OROBELLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:NICK
Other - Middle Name:CARY
Other - Last Name:OROBELLO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:8950 DR MLK JR STREET N
Mailing Address - Street 2:SUITE 150
Mailing Address - City:ST. PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702
Mailing Address - Country:US
Mailing Address - Phone:727-329-5400
Mailing Address - Fax:
Practice Address - Street 1:8950 DR MLK JR STREET N
Practice Address - Street 2:SUITE 150
Practice Address - City:ST. PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702
Practice Address - Country:US
Practice Address - Phone:727-329-5400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-17
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
DC210002132207YP0228X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program