Provider Demographics
NPI:1801674510
Name:SKANDY SPINE & SPECIALISTS LLC
Entity type:Organization
Organization Name:SKANDY SPINE & SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THEOPHILOS
Authorized Official - Middle Name:
Authorized Official - Last Name:SKANDALIARIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-623-9402
Mailing Address - Street 1:3491 GANDY BLVD N STE 205
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33781-2654
Mailing Address - Country:US
Mailing Address - Phone:727-623-9402
Mailing Address - Fax:727-623-9406
Practice Address - Street 1:3491 GANDY BLVD N STE 205
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-2654
Practice Address - Country:US
Practice Address - Phone:727-623-9402
Practice Address - Fax:727-623-9406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-15
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty