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General NPI Number Information
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NPI Number | 1265075261
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Entity Type | Organization
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Legal Business Name | LIFESTREAM FAMILY MEDICINE P.A.
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Dates
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Enumeration Date | 10/22/2019
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Last Update Date | 07/10/2020
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Provider Practice Location Address
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Address Line | 1957 WORTH COURT
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City | BRADENTON
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State | FL
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Zip | 34211
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Country | US
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Telephone | 941-755-0433
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Fax |
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Provider Business Mailing Address
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Address Line | 1957 WORTH COURT
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City | BRADENTON
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State | FL
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Zip | 34211
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Country | US
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Telephone | 941-755-0433
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Fax |
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Authorized Official
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Title or Position | CEO/OWNER
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Name | SASKA FIONA SOOKRA WINSLOW
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Credential | M.D.
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Telephone | 941-755-0433
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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