Healthcare Provider Details

I. General information

NPI: 1912058124
Provider Name (Legal Business Name): SARASOTA PLASTIC SURGERY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 04/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2255 S. TAMIAMI TRAIL
SARASOTA FL
34239-3806
US

IV. Provider business mailing address

2255 S. TAMIAMI TRAIL
SARASOTA FL
34239-3806
US

V. Phone/Fax

Practice location:
  • Phone: 941-366-8897
  • Fax: 941-366-0518
Mailing address:
  • Phone: 941-366-8897
  • Fax: 941-366-0518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. DEVONNE M LABONTE
Title or Position: CEO ADMINISTRATOR
Credential: MHA, LHRM, CASC
Phone: 941-366-8897