MEDICARE: SAMMY & DIVINCENZO, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CF1471	OTHER	FL	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1477610400
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAMMY & DIVINCENZO, PA

Provider Business Mailing Address
First Line	:	3003 26TH ST W
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34205-3739
Country	:	US
Telephone Number	:	941-753-1234
Fax Number	:	941-755-1332

Provider Business Practice Location Address
First Line	:	3003 26TH ST W
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34205-3739
Country	:	US
Telephone Number	:	941-753-1234
Fax Number	:	941-755-1332

Authorized Official
Title or Position	:	OWNER
Name	:	RAMDIN V SAMMY
Credential	:	D.PM.
Telephone Number	:	941-753-1234

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	05/17/2012

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Directions to “SAMMY & DIVINCENZO, PA ” Practice Location

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