Provider Demographics
NPI:1174173421
Name:PINELLAS VASCULAR LLC
Entity type:Organization
Organization Name:PINELLAS VASCULAR LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:AVIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUNNELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-999-8346
Mailing Address - Street 1:5260 78TH AVE N # 2776
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33781-2347
Mailing Address - Country:US
Mailing Address - Phone:727-999-8346
Mailing Address - Fax:877-743-4465
Practice Address - Street 1:5880 49TH ST N STE 206
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-2147
Practice Address - Country:US
Practice Address - Phone:813-997-2099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-18
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty