Provider Demographics
NPI:1740213305
Name:CANODY PEDIATRICS, PA
Entity type:Organization
Organization Name:CANODY PEDIATRICS, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:CANODY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-879-5716
Mailing Address - Street 1:5124 N ARMENIA AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-1406
Mailing Address - Country:US
Mailing Address - Phone:813-879-5716
Mailing Address - Fax:813-877-4890
Practice Address - Street 1:5124 N ARMENIA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-1406
Practice Address - Country:US
Practice Address - Phone:813-879-5716
Practice Address - Fax:813-877-4890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17458174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty