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Organization
ST. JUDE MEDICAL & AESTHETIC CARE CENTER, LLC
Active
Organization
ST. JUDE MEDICAL & AESTHETIC CARE CENTER, LLC
Active
Other names
St. Jude Medical Center & Aesthetic Care
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GODWIN STANLEY OKOYE MD (MEDICAL DIRECTOR)
(813) 330-6613
Entity
Organization
Contact information
Practice address
131 N MOON AVE, SUITES 3 & 4, BRANDON, FL 33510-4418
(813) 315-9898
(813) 438-5967
Mailing address
4810 PORTOBELLO CIR, VALRICO, FL 33596
(813) 315-9898
Taxonomy
Speciality
Code
Description
License number
State
132700000X
Dietary Manager
—
NULL
132700000X
Dietary Manager
—
—
146D00000X
Personal Emergency Response Attendant
ME107980
FL
207QA0401X
Addiction Medicine (Family Medicine) Physician
ME107980
FL
207W00000X
Ophthalmology Physician
Primary
ME107980
FL
2083P0901X
Public Health & General Preventive Medicine Physician
—
NULL
2083P0901X
Public Health & General Preventive Medicine Physician
—
—
208D00000X
General Practice Physician
ME107980
FL
208U00000X
Clinical Pharmacology Physician
ME107980
FL
Other
Enumeration date
12/06/2010
Last updated
10/08/2013
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