Healthcare Provider Details

I. General information

NPI: 1346251089
Provider Name (Legal Business Name): DEAN PATRICK SUTHERLAND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 03/16/2020
Certification Date: 03/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1921 WALDEMERE ST STE 701
SARASOTA FL
34239-2913
US

IV. Provider business mailing address

PO BOX 863407
ORLANDO FL
32886-3407
US

V. Phone/Fax

Practice location:
  • Phone: 941-487-2160
  • Fax: 941-487-2170
Mailing address:
  • Phone: 941-917-2600
  • Fax: 941-917-7884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME79474
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: