Provider Demographics
NPI:1962479931
Name:ACEVEDO, MARTHA T (MD)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:T
Last Name:ACEVEDO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6801 SHELDON RD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-2754
Mailing Address - Country:US
Mailing Address - Phone:813-885-1770
Mailing Address - Fax:813-889-8078
Practice Address - Street 1:6801 SHELDON RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-2754
Practice Address - Country:US
Practice Address - Phone:813-885-1770
Practice Address - Fax:813-889-8078
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME94008208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics