Healthcare Provider Details

I. General information

NPI: 1265463772
Provider Name (Legal Business Name): DAVID A. SUNNENBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 02/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 W MILLER ST
ORLANDO FL
32806-2032
US

IV. Provider business mailing address

1300 SAWGRASS CORPORATE PKWY STE. 200
SUNRISE FL
33323-2826
US

V. Phone/Fax

Practice location:
  • Phone: 727-456-4250
  • Fax: 727-346-1044
Mailing address:
  • Phone: 800-243-3839
  • Fax: 954-858-0404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.087677
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME99191
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME99191
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: