Healthcare Provider Details

I. General information

NPI: 1114819620
Provider Name (Legal Business Name): SUNCOAST SPINE AND PAIN INSTITUTE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2025
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 OLD CAMP RD STE 180
THE VILLAGES FL
32162-5605
US

IV. Provider business mailing address

9835 LAKE WORTH RD STE 16-143
LAKE WORTH FL
33467-2300
US

V. Phone/Fax

Practice location:
  • Phone: 407-680-2026
  • Fax: 407-680-0911
Mailing address:
  • Phone: 407-680-2026
  • Fax: 407-680-0911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GERARD DEIB
Title or Position: OWNER
Credential: MD
Phone: 407-409-1987