Individual
LYSSA EDMUNDS LOGUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO, MPH
Contact information
Practice address
5033 CENTRAL AVE, SAINT PETERSBURG, FL 33710-8240
(727) 334-8523
(727) 292-1164
Mailing address
5033 CENTRAL AVE, SAINT PETERSBURG, FL 33710-8240
(727) 334-8523
(727) 292-1164
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
OS11269
FL
390200000X
Student in an Organized Health Care Education/Training Program
UO1839
FL
Other
Enumeration date
06/10/2008
Last updated
03/06/2023
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