Provider Demographics
NPI:1528148822
Name:FELDMAN, PHYLLIS SIROTTA (MD)
Entity type:Individual
Prefix:DR
First Name:PHYLLIS
Middle Name:SIROTTA
Last Name:FELDMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 917770
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-0001
Mailing Address - Country:US
Mailing Address - Phone:813-974-2201
Mailing Address - Fax:813-974-2812
Practice Address - Street 1:4202 E FOWLER AVE
Practice Address - Street 2:SHS 100
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33620-6750
Practice Address - Country:US
Practice Address - Phone:813-974-2331
Practice Address - Fax:813-974-5888
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME 405222084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL250825700Medicaid
FL30692OtherBLUE CROSS BLUE SHIELD
FLHK311ZMedicare PIN