Healthcare Provider Details

I. General information

NPI: 1720892839
Provider Name (Legal Business Name): SYNERGY ONE ORTHOPEDICS & SPORTS MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2025
Last Update Date: 06/13/2026
Certification Date: 06/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3277 FRUITVILLE RD # A2
SARASOTA FL
34237-6410
US

IV. Provider business mailing address

2201 CANTU CT STE 116
SARASOTA FL
34232-6254
US

V. Phone/Fax

Practice location:
  • Phone: 941-500-2736
  • Fax: 941-200-3827
Mailing address:
  • Phone: 941-500-2736
  • Fax: 941-200-3827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: ANDREW MUNDY
Title or Position: MGR
Credential: MD
Phone: 423-584-1539