=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689031551
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MAHENDRA POONAI NP
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/24/2016
-----------------------------------------------------
Last Update Date | 12/16/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3578 CLARK RD STE 125
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34231-8408
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-229-0039
-----------------------------------------------------
Fax | 941-237-4125
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3578 CLARK RD STE 125
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34231-8408
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-284-3506
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 9308899
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------