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General NPI Number Information
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NPI Number | 1124491816
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Entity Type | Organization
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Legal Business Name | SANFORD PEDIATRIC ASSOCIATES PA
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Dates
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Enumeration Date | 11/04/2015
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Last Update Date | 11/04/2015
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Provider Practice Location Address
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Address Line | 775 HARLEY STRICKLAND BLVD SUITE 101
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City | ORANGE CITY
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State | FL
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Zip | 32763-7963
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Country | US
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Telephone | 386-851-0644
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Fax | 386-851-0664
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Provider Business Mailing Address
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Address Line | 775 HARLEY STRICKLAND BLVD SUITE 101
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City | ORANGE CITY
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State | FL
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Zip | 32763-7963
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Country | US
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Telephone | 386-851-0644
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Fax | 386-851-0664
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN EDWARD TERWILLEGER
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Credential | M.D.
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Telephone | 386-851-0644
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number | ME0045959
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License Number State | FL
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