Healthcare Provider Details

I. General information

NPI: 1295495166
Provider Name (Legal Business Name): KONICA SINGLA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2021
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 UNIVERSITY PKWY STE 205
SARASOTA FL
34243-2973
US

IV. Provider business mailing address

2401 UNIVERSITY PKWY STE 205
SARASOTA FL
34243-2973
US

V. Phone/Fax

Practice location:
  • Phone: 267-237-6153
  • Fax:
Mailing address:
  • Phone: 941-351-1200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberME165104
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberLT000877
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: