Healthcare Provider Details

I. General information

NPI: 1518658632
Provider Name (Legal Business Name): JOHN F MASSARO JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2023
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 S BENEVA RD
SARASOTA FL
34232-2401
US

IV. Provider business mailing address

921 S BENEVA RD
SARASOTA FL
34232-2401
US

V. Phone/Fax

Practice location:
  • Phone: 941-365-7390
  • Fax: 941-365-5469
Mailing address:
  • Phone: 941-365-7390
  • Fax: 941-365-5469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS24192
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: