Healthcare Provider Details

I. General information

NPI: 1124058334
Provider Name (Legal Business Name): PANDYA KING GROUP PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 04/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1656 MEDICAL BLVD STE 302
NAPLES FL
34110-1423
US

IV. Provider business mailing address

PO BOX 161557
MIAMI FL
33116-1557
US

V. Phone/Fax

Practice location:
  • Phone: 239-513-0363
  • Fax: 239-513-7923
Mailing address:
  • Phone: 239-513-0363
  • Fax: 239-513-7923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SUNIL RAMESH PANDYA
Title or Position: PRESIDENT
Credential: MD
Phone: 239-287-0798