Healthcare Provider Details

I. General information

NPI: 1528678026
Provider Name (Legal Business Name): SPECTRUM PLASTIC SURGERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2020
Last Update Date: 08/18/2020
Certification Date: 08/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2426 S TAMIAMI TRL
SARASOTA FL
34239-3842
US

IV. Provider business mailing address

PO BOX 3612
SARASOTA FL
34230-3612
US

V. Phone/Fax

Practice location:
  • Phone: 507-398-2753
  • Fax: 941-866-9024
Mailing address:
  • Phone: 507-398-2753
  • Fax: 941-866-9024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: ALEX SENCHENKOV
Title or Position: MD/OWNER
Credential: MD
Phone: 507-398-2753