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General NPI Number Information
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NPI Number | 1154577021
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Entity Type | Organization
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Legal Business Name | SUNDARI PLASTICS LLC
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Dates
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Enumeration Date | 08/12/2008
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Last Update Date | 04/19/2011
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Provider Practice Location Address
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Address Line | 14100 FIVAY RD SUITE 130
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City | HUDSON
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State | FL
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Zip | 34667-7180
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Country | US
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Telephone | 727-378-5808
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Fax | 727-378-5810
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Provider Business Mailing Address
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Address Line | PO BOX 5441
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City | HUDSON
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State | FL
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Zip | 34674-5441
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Country | US
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Telephone | 727-378-5808
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Fax | 727-378-5810
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN BARRY ROACH JR.
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Credential | D.O.
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Telephone | 727-378-5808
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | OS9566
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | OS9566
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License Number State | FL
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