Provider Demographics
NPI:1528118726
Name:PEDIATRIC ASSOCIATES OF SARASOTA
Entity type:Organization
Organization Name:PEDIATRIC ASSOCIATES OF SARASOTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:SHAMSEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-366-3000
Mailing Address - Street 1:1215 S EAST AVE
Mailing Address - Street 2:SUITE # 303
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-2342
Mailing Address - Country:US
Mailing Address - Phone:941-366-3000
Mailing Address - Fax:941-366-3002
Practice Address - Street 1:1215 S EAST AVE
Practice Address - Street 2:SUITE # 303
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2342
Practice Address - Country:US
Practice Address - Phone:941-366-3000
Practice Address - Fax:941-366-3002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME345302080A0000X
FLME576722080A0000X
FLME809602080A0000X
FLME221852080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL045457500Medicaid
FL045457500Medicaid