Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | ME 103424 | FL |
N | 2080P0201X | Pediatric Allergist | ME 103424 | FL |
NPI | 1891994208 |
---|---|
Provider Name | Dr. Panida Sriaroon |
First Address | Orlando, FL 32891-0001 |
Second Address | Saint Petersburg, FL 33701-4816 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2007 |
Last Update Date | 27/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001028400 | (05) | FL |
145J1 | BLUE CROSS BLUE SHIELD (01) | FL |