DR. VITALY BORODIN (NPI# 1659702553) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1659702553 |
| Entity Type | Individual |
| Full Name | DR. VITALY BORODIN |
| Other Name | VITALII SERGEEVICH BORODIN |
| Credential | M.D. |
| Practice Address |
5481 W Waters Ave Tampa FL 33634-1205 |
| Mailing Address |
11 Peachtree Ln Danville PA 17821-8452 |
| Practice Telephone | 4843507158 |
| Enumeration Date | 2013-12-03 |
| Last Update Date | 2018-04-05 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207ZC0500X |
Pathology Specialization: Cytopathology |
ME135873 | FL | Allopathic & Osteopathic Physicians |
| N | 207ZP0007X |
Pathology Specialization: Molecular Genetic Pathology |
ME135873 | FL | Allopathic & Osteopathic Physicians |
| N | 207ZP0007X |
Pathology Specialization: Molecular Genetic Pathology |
0116028958 | VA | Allopathic & Osteopathic Physicians |
| N | 207ZP0102X |
Pathology Specialization: Anatomic Pathology & Clinical Pathology |
ME135873 | FL | Allopathic & Osteopathic Physicians |
| N | 207ZP0102X |
Pathology Specialization: Anatomic Pathology & Clinical Pathology |
MT201400 | PA | Allopathic & Osteopathic Physicians |
| Y | 390200000X | Student in an Organized Health Care Education/Training Program | 0116028958 | VA | Student, Health Care |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1250 E. Marshall St, Pob 980662, Richmond, VA 232980662 | 8048280561 |
| Street Address |
5481 W WATERS AVE |
| City | TAMPA |
| State | FL |
| Zip Code | 33634-1205 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033697420 | Sarah Booker Hugar | Pathology | 5481 W Waters Ave, Tampa, FL 33634-1205 | 2018-07-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134729510 | Magaly Lozada | Pharmacist | 7011 West Waters Ave, Tampa, FL 33634 | 2020-10-27 |
| 1396223798 | Kayla Lashae Keaton | Developmental Therapist | 5091 Florida Mining Blvd, Suite 102, Tampa, FL 33634 | 2018-07-30 |
| 1396221008 | Hannah L. Fox | Developmental Therapist | 5091 Florida Mining Blvd., Suite 102, Tampa, FL 33634 | 2018-07-16 |
| 1417443623 | Leah Patrinostro | Developmental Therapist | 5091 Florida Mining Blvd, Suite 102, Tampa, FL 33634 | 2018-07-11 |
| 1265889208 | Shannon Stumbaugh | Specialist/Technologist, Other | 5224 Net Drive Apt 315, Tampa, FL 33634 | 2016-05-19 |
| 1487024469 | Brenda I Bryant | Counselor | 4902 Eisenhower Blvd Ste 295, Tampa, FL 33634 | 2015-10-02 |
| 1548697790 | Arlene A. Laing | Nurse Practitioner | 9009 Corporate Lake Drive, Suite 200, Tampa, FL 33634 | 2013-10-02 |
| 1942642301 | Yanet D. Perez Parra | Registered Nurse | 6821 W Hillsborough Ave Ste 10-11, Tampa, FL 33634 | 2013-07-25 |
| 1467794784 | Deanna Lynn Marr | Occupational Therapist | 6169 Lanshire Dr, Tampa, FL 33634 | 2013-03-25 |
| 1336489442 | Elbert Jamaal Taylor | Technician, Other | 8905 Benjamin Road, Tampa, FL 33634 | 2013-02-26 |
| Find all providers in zip 33634 | ||||
| Taxonomy Code | 390200000X |
| Grouping | Student, Health Care |
| Classification | Student in an Organized Health Care Education/Training Program |
| An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |
| Notes: [1/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326649682 | Margely Carrion | Student in an Organized Health Care Education/Training Program | 4931 Town N Country Blvd, Tampa, FL 33615-4640 | 2020-11-03 |
| 1699374785 | Meghan Elizabeth Berry | Student in an Organized Health Care Education/Training Program | 6621 Canopy Lakes Ct Apt 402, Tampa, FL 33625-4174 | 2020-10-20 |
| 1578162947 | Hayly Alexandrea Babcock | Student in an Organized Health Care Education/Training Program | 936 S Howard Ave Unit 305, Tampa, FL 33606-2492 | 2020-10-18 |
| 1821605023 | Jenna Vachon | Student in an Organized Health Care Education/Training Program | 7413 S West Shore Blvd, Tampa, FL 33616-2818 | 2020-09-30 |
| 1255947131 | Jesse Wood | Student in an Organized Health Care Education/Training Program | 124 S Morgan St Unit 1123, Tampa, FL 33602-5325 | 2020-09-16 |
| 1053925321 | Miranda Nunez | Student in an Organized Health Care Education/Training Program | 2806 W Powhatan Ave, Tampa, FL 33614-6039 | 2020-09-03 |
| 1114536141 | Natalie Michelle Fernandez | Student in an Organized Health Care Education/Training Program | 3107 N Perry Ave, Tampa, FL 33603-5346 | 2020-07-27 |
| 1215552112 | Yaimara Pena | Student in an Organized Health Care Education/Training Program | 10134 Lake Oak Cir, Tampa, FL 33624-5214 | 2020-06-16 |
| 1538784780 | Kristen N Moeller | Student in an Organized Health Care Education/Training Program | 6119 D and J Dr, Tampa, FL 33625-3264 | 2020-06-13 |
| 1548884513 | Bassam Aysheh | Student in an Organized Health Care Education/Training Program | 10350 Rosemount Dr, Tampa, FL 33624-5122 | 2020-06-04 |
| Find all providers in TAMPA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.