Healthcare Provider Details

I. General information

NPI: 1689335911
Provider Name (Legal Business Name): JUSTIN SACHS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2022
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5304 4TH AVENUE CIR E
BRADENTON FL
34208-5624
US

IV. Provider business mailing address

5304 4TH AVENUE CIR E
BRADENTON FL
34208-5624
US

V. Phone/Fax

Practice location:
  • Phone: 941-761-2900
  • Fax:
Mailing address:
  • Phone: 941-761-2900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberPA9116928
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number0110008816
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberPA9116928
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: