Healthcare Provider Details

I. General information

NPI: 1306015359
Provider Name (Legal Business Name): JAMES D SHORTT M D P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2008
Last Update Date: 03/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5741 BEE RIDGE RD SUITE 590
SARASOTA FL
34233-5064
US

IV. Provider business mailing address

PO BOX 25036
SARASOTA FL
34277-2036
US

V. Phone/Fax

Practice location:
  • Phone: 941-955-1231
  • Fax: 941-378-3444
Mailing address:
  • Phone: 941-955-1231
  • Fax: 941-378-3444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number StateFL

VIII. Authorized Official

Name: MRS. KIMBERLY ANN CIRIECO
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 941-955-1231