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General NPI Number Information
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NPI Number | 1205460995
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Entity Type | Organization
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Legal Business Name | SUNCOAST MEDICAL GROUP LLC
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Dates
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Enumeration Date | 03/03/2020
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Last Update Date | 03/03/2020
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Provider Practice Location Address
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Address Line | 1154 LEE BLVD STE 4
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City | LEHIGH ACRES
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State | FL
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Zip | 33936-4852
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Country | US
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Telephone | 239-368-5757
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Fax |
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Provider Business Mailing Address
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Address Line | 3208 NW 1ST AVE
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City | CAPE CORAL
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State | FL
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Zip | 33993-6776
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Country | US
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Telephone | 239-687-0194
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Fax |
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Authorized Official
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Title or Position | MGR
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Name | MRS. YAJAIDA ARISTHYL
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Credential | APRN
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Telephone | 239-687-0194
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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