NPIMap

Organization Active NPI

Florida Pediatric Associates, LLC

  • Pediatrics Physician
  • Maitland, FL
National Provider Identifier
1376846733
Registry record updated Aug 10, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
FLORIDA PEDIATRIC ASSOCIATES, LLC
Practice address
790 Concourse Pkwy S
Suite 200
Maitland, FL 32751-6114
Phone
(407) 767-6411
Fax
(407) 767-8160
NPI assigned
Dec 7, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Sheila A Tatham
Title
Credentialing Manager
Phone
(727) 456-4250

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

790 Concourse Pkwy S
Suite 200
Maitland, FL 32751-6114

Mailing address

1800 Dr Martin Luther King Jr St N
St Petersburg, FL 33704-4222
Phone (727) 456-3288

Other identifiers 2

IdentifierTypeStateIssuer
256303739MedicaidFL
38313OtherFLMEDICARE PTAN

Other names 1

  • Florida Pediatric Assoc Optical Maitland Other name

National Provider Directory

National Provider Directory
Tax ID family
Ace Florida Pediatric a2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1291680000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1786320000000",
    "number": "1376846733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 DR MARTIN LUTHER KING JR ST N",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337044222",
            "telephone_number": "727-456-3288",
            "fax_number": "727-456-3289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "790 CONCOURSE PKWY S",
            "address_2": "SUITE 200",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "327516114",
            "telephone_number": "407-767-6411",
            "fax_number": "407-767-8160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FLORIDA PEDIATRIC ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-07",
        "last_updated": "2026-08-10",
        "certification_date": "2026-08-10",
        "status": "A",
        "authorized_official_last_name": "TATHAM",
        "authorized_official_first_name": "SHEILA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "727-456-4250"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "256303739",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "38313",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Florida Pediatric Assoc Optical Maitland",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Maitland, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.