Healthcare Provider Details

I. General information

NPI: 1174924757
Provider Name (Legal Business Name): SUMTER PEDIATRICS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2014
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

617 S US 301 STE B
SUMTERVILLE FL
33585-5355
US

IV. Provider business mailing address

617 S US 301 STE B
SUMTERVILLE FL
33585-5355
US

V. Phone/Fax

Practice location:
  • Phone: 352-569-4980
  • Fax: 352-569-4981
Mailing address:
  • Phone: 352-569-4980
  • Fax: 352-569-4981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME72542
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License NumberME72542
License Number StateFL

VIII. Authorized Official

Name: DR. MOHAMMAD AFZAL
Title or Position: DOCTOR
Credential: MD
Phone: 352-394-3929