Active NPI
Sean Michael Russo, CPO
- Specialist
- St Petersburg, FL
National Provider Identifier
1063664605
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- POR177
- Practice address
- 3611 5TH Ave N
St Petersburg, FL 33713-7503 - Phone
- (727) 327-3332
- Fax
- (727) 327-7304
- NPI assigned
- Oct 15, 2008
- Last updated
- Oct 15, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | POR177 | FL | Primary |
Addresses
Primary practice location
3611 5TH Ave N
St Petersburg, FL 33713-7503
Mailing address
3611 5TH Ave N
St Petersburg, FL 33713-7503
Phone (727) 327-3332
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| POR177 | FL | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1224028800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1224028800000",
"number": "1063664605",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3611 5TH AVE N",
"city": "ST PETERSBURG",
"state": "FL",
"postal_code": "337137503",
"telephone_number": "727-327-3332",
"fax_number": "727-327-7304"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3611 5TH AVE N",
"city": "ST PETERSBURG",
"state": "FL",
"postal_code": "337137503",
"telephone_number": "727-327-3332",
"fax_number": "727-327-7304"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSO",
"first_name": "SEAN",
"middle_name": "MICHAEL",
"name_prefix": "Mr.",
"credential": "CPO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-10-15",
"last_updated": "2008-10-15",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "FL",
"license": "POR177",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in St Petersburg, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.