Healthcare Provider Details

I. General information

NPI: 1396829818
Provider Name (Legal Business Name): THOMAS JOSEPH SULTENFUSS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 01/18/2024
Certification Date: 01/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 HARBOR VIEW LN
BELLEAIR BLUFFS FL
33770-2605
US

IV. Provider business mailing address

102 HARBOR VIEW LN
BELLEAIR BLUFFS FL
33770-2605
US

V. Phone/Fax

Practice location:
  • Phone: 727-385-9052
  • Fax:
Mailing address:
  • Phone: 727-385-9052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME34798
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: