=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073057311
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SINGH MEDICAL GROUP, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/06/2016
-----------------------------------------------------
Last Update Date | 05/01/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14153 YOSEMITE DR SUITE 101
-----------------------------------------------------
City | HUDSON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34667-8060
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-222-0806
-----------------------------------------------------
Fax | 727-233-9737
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14153 YOSEMITE DR SUITE 101
-----------------------------------------------------
City | HUDSON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34667-8060
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-222-0806
-----------------------------------------------------
Fax | 727-233-9737
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT
-----------------------------------------------------
Name | SUNANDA SINGH
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 813-892-6599
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number | ME73174
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2082S0105X
-----------------------------------------------------
Taxonomy Name | Surgery of the Hand (Plastic Surgery) Physician
-----------------------------------------------------
License Number | ME79778
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------