Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Cody Wallace Dewitt, PA

Individual provider Physician Assistant · NPI 1073397998

Cody Wallace Dewitt, PA is a Physician Assistant in Largo, Florida. Qualified in 2023, 3 years ago. Practices with Sanford Bismarck, a 561-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Florida and North Dakota.

Years since qualifying
3
Licensed in
FL, ND
In the registry since
2023
Specialties on file
2
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

201 14th St SW
Largo, FL 33770-3133
Phone: (727) 588-5200
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 300 Pinellas St, Clearwater, FL 33756-3892 — (727) 462-7000

Specialties & licences

Medical Physician Assistant (primary) Taxonomy 363AM0700X · Licence 9117778 (FL)
Physician Assistant Taxonomy 363A00000X · Licence PAC1142 (ND)

Record details

NPI number1073397998
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorNo
NPI enumeratedAugust 22, 2023
Last updated in NPPESMarch 5, 2025
Certification dateMarch 5, 2025
Mailing address9505 49th St N Apt 1-306, Pinellas Park, FL 33782-5275

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Group practice Sanford Bismarck — 561 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations4 on file with Medicare

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