Provider Demographics
NPI:1750399226
Name:PASTO MANETTA, LESLIE A (PA-C)
Entity type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:A
Last Name:PASTO MANETTA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6827 1ST AVE S
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33707-1242
Mailing Address - Country:US
Mailing Address - Phone:727-767-0575
Mailing Address - Fax:727-333-6020
Practice Address - Street 1:13670 WALSINGHAM ROAD
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33774
Practice Address - Country:US
Practice Address - Phone:727-593-9848
Practice Address - Fax:727-596-4532
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9100641363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL292880900Medicaid
FL292880900Medicaid
FLE4553WMedicare PIN