Provider Demographics
NPI:1215280615
Name:F.M. ANTONIETA SCHETTINO, MD PA
Entity type:Organization
Organization Name:F.M. ANTONIETA SCHETTINO, MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FM
Authorized Official - Middle Name:ANTONIETA
Authorized Official - Last Name:SCHETTINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-464-1444
Mailing Address - Street 1:8335 NW 12TH ST
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33126-1841
Mailing Address - Country:US
Mailing Address - Phone:786-464-1444
Mailing Address - Fax:786-845-8568
Practice Address - Street 1:8335 NW 12TH ST
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33126-1841
Practice Address - Country:US
Practice Address - Phone:786-464-1444
Practice Address - Fax:786-845-8568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-23
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL259975900Medicaid