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General NPI Number Information
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NPI Number | 1396984688
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Entity Type | Organization
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Legal Business Name | SUNSHINE STATE ANESTHESIA ASSOCIATES,P.L.
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Dates
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Enumeration Date | 02/11/2009
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Last Update Date | 01/04/2012
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Provider Practice Location Address
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Address Line | 201 NOLAND DR SUITE A
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City | BRANDON
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State | FL
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Zip | 33511
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Country | US
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Telephone | 352-688-6393
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Fax | 352-688-1113
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Provider Business Mailing Address
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Address Line | PO BOX 10390
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City | BROOKSVILLE
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State | FL
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Zip | 34603
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Country | US
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Telephone | 352-688-6393
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Fax | 352-688-1113
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. JEAN M SIDHOM
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Credential |
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Telephone | 813-731-0416
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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