Healthcare Provider Details

I. General information

NPI: 1396890422
Provider Name (Legal Business Name): EASTERSEALS OF SOUTHWEST FLORIDA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 05/18/2025
Certification Date: 05/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 BRADEN AVE
SARASOTA FL
34243-2001
US

IV. Provider business mailing address

350 BRADEN AVE
SARASOTA FL
34243-2001
US

V. Phone/Fax

Practice location:
  • Phone: 941-355-7637
  • Fax: 941-444-2271
Mailing address:
  • Phone: 941-355-7637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TOM WATERS
Title or Position: CEO
Credential:
Phone: 941-355-7637