Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | ME133419 | FL |
NPI | 1144519034 |
---|---|
Provider Name | Peter Sambatakos |
First Address | St Petersburg, FL 33701-4634 |
Second Address | St Petersburg, FL 33701-4634 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2011 |
Last Update Date | 04/08/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
FS6982044 | DEA (01) | FL |