Active NPI
Matthew Miceli
- Psychologist
- St Petersburg, FL
National Provider Identifier
1124780333
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- Practice address
- 146 2ND St N Ste 305
St Petersburg, FL 33701-3361 - Phone
- (727) 289-6583
- NPI assigned
- Oct 6, 2021
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | Primary |
Addresses
Primary practice location
146 2ND St N Ste 305
St Petersburg, FL 33701-3361
Mailing address
146 2ND St N Ste 305
Saint Petersburg, FL 33701-3361
Phone (727) 289-6583
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PY11206 | Other | FL | FLORIDA DEPARTMENT OF HEALTH |
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)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1633478400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1633478400000",
"number": "1124780333",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "146 2ND ST N STE 305",
"city": "SAINT PETERSBURG",
"state": "FL",
"postal_code": "337013361",
"telephone_number": "727-289-6583"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "146 2ND ST N STE 305",
"city": "ST PETERSBURG",
"state": "FL",
"postal_code": "337013361",
"telephone_number": "727-289-6583"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MICELI",
"first_name": "MATTHEW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-10-06",
"last_updated": "2021-10-06",
"certification_date": "2021-10-06",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FLORIDA DEPARTMENT OF HEALTH",
"identifier": "PY11206",
"state": "FL"
}
],
"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 6, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.