# ST. JUDE MEDICAL & AESTHETIC CARE CENTER, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** St. Jude Medical Center & Aesthetic Care
- **Organization subpart:** No

## Provider details

- **NPI number:** 1518260090
- **Authorized official:** DR. GODWIN STANLEY OKOYE MD (MEDICAL DIRECTOR)
- **Authorized official phone:** (813) 330-6613

## Contact information

- **Practice address:** 131 N MOON AVE, SUITES 3 & 4, BRANDON, FL 33510-4418
- **Practice address phone:** (813) 315-9898
- **Practice address fax:** (813) 438-5967
- **Mailing address:** 4810 PORTOBELLO CIR, VALRICO, FL 33596
- **Mailing address phone:** (813) 315-9898

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 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 | ME107980 | FL | Yes |
| 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