Healthcare Provider Details

I. General information

NPI: 1063670255
Provider Name (Legal Business Name): WOMEN'S CHOICE ONCOLOGY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2008
Last Update Date: 05/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3425 UNIVERSITY PARKWAY UNIT 102
SARASOTA FL
34243
US

IV. Provider business mailing address

3425 UNIVERSITY PARKWAY UNIT 102
SARASOTA FL
34243-4241
US

V. Phone/Fax

Practice location:
  • Phone: 941-746-7507
  • Fax: 941-746-7579
Mailing address:
  • Phone: 941-746-7507
  • Fax: 941-351-2668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberME101589
License Number StateFL

VIII. Authorized Official

Name: STACEY ANN SOUTH
Title or Position: MANAGING DIRECTOR
Credential: MD
Phone: 941-993-6644