Provider Demographics
NPI:1558652040
Name:FSU PEDIATRIC RESIDENCY PROGRAM
Entity type:Organization
Organization Name:FSU PEDIATRIC RESIDENCY PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENT/PGY3
Authorized Official - Prefix:DR
Authorized Official - First Name:POOJA
Authorized Official - Middle Name:
Authorized Official - Last Name:KASHYAP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-229-8770
Mailing Address - Street 1:8955 ABBINGTON DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32534-5347
Mailing Address - Country:US
Mailing Address - Phone:630-229-8770
Mailing Address - Fax:
Practice Address - Street 1:5151 N 9TH AVE
Practice Address - Street 2:6TH FLOOR NEMOURS CHILDRENS CLINIC
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8721
Practice Address - Country:US
Practice Address - Phone:850-416-7658
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-02
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN15533282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren