Organization
PEDIATRIC & ADOLESCENT HEALTH ASSOCIATES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TABASSUM SHAMIM M.D. (MEDICAL DIRECTOR)
(860) 874-8374
Entity
Organization
Contact information
Practice address
3709 W HAMILTON AVE STE 4, TAMPA, FL 33614-4015
(813) 515-7988
Mailing address
PO BOX 270663, TAMPA, FL 33688-0663
(813) 515-7988
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
ME115364
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010853700
—
FL
Enumeration date
10/13/2014
Last updated
09/18/2015
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