Healthcare Provider Details

I. General information

NPI: 1306032586
Provider Name (Legal Business Name): PODIATRY ASSOCIATES OF FLORIDA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2007
Last Update Date: 09/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 SOUTHPARK CIR E
ST AUGUSTINE FL
32086-5135
US

IV. Provider business mailing address

3117 SPRING GLEN RD STE 402
JACKSONVILLE FL
32207-5906
US

V. Phone/Fax

Practice location:
  • Phone: 904-829-2855
  • Fax: 904-829-0672
Mailing address:
  • Phone: 904-224-2001
  • Fax: 904-224-2002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: SUSAN G SINCHUK
Title or Position: BUSINESS ADMINISTRATOR
Credential:
Phone: 904-224-2001