Healthcare Provider Details

I. General information

NPI: 1225234404
Provider Name (Legal Business Name): INTEGRATED COMMUNITY ONCOLOGY NETWORK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 05/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N MANGOUSTINE AVE
SANFORD FL
32771-1017
US

IV. Provider business mailing address

PO BOX 19675
JACKSONVILLE FL
32245-9675
US

V. Phone/Fax

Practice location:
  • Phone: 407-833-7518
  • Fax: 407-833-7514
Mailing address:
  • Phone: 904-346-3338
  • Fax: 904-346-0815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: SHYAM B PARYANI
Title or Position: DIRECTOR
Credential:
Phone: 904-346-3338