Healthcare Provider Details

I. General information

NPI: 1700947884
Provider Name (Legal Business Name): SUNTREE INTERNAL MEDICINE, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6619 N WICKHAM RD
MELBOURNE FL
32940-2006
US

IV. Provider business mailing address

6619 N WICKHAM RD
MELBOURNE FL
32940-2006
US

V. Phone/Fax

Practice location:
  • Phone: 321-259-9500
  • Fax: 321-253-1777
Mailing address:
  • Phone: 321-259-9500
  • Fax: 321-253-1777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ABE HARDOON
Title or Position: DIRECTOR MD
Credential: MD
Phone: 321-259-9500