Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0201X | Pediatric Allergist | ME114556 | FL |
NPI | 1134394596 |
---|---|
Provider Name | Sthorn Thatayatikom |
First Address | Rockland, DE 19732-0191 |
Second Address | Gainesville, FL 32610-0296 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2008 |
Last Update Date | 03/05/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
007647400 | (05) | FL |