Healthcare Provider Details

I. General information

NPI: 1013853357
Provider Name (Legal Business Name): MY SIDE MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1679 EAGLE HARBOR PKWY
FLEMING ISLAND FL
32003-4815
US

IV. Provider business mailing address

797 PEPPERVINE AVE
ST JOHNS FL
32259-5276
US

V. Phone/Fax

Practice location:
  • Phone: 904-289-1850
  • Fax:
Mailing address:
  • Phone: 904-289-1850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SEAN SIDEY
Title or Position: MANAGING MEMBER
Credential:
Phone: 904-289-1850