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General NPI Number Information
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NPI Number | 1700375458
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Entity Type | Organization
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Legal Business Name | SUNSHINE STATE PODIATRY LLC
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Dates
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Enumeration Date | 05/08/2018
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Last Update Date | 12/14/2018
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Provider Practice Location Address
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Address Line | 24830 BURNT PINE DR STE 3
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City | BONITA SPRINGS
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State | FL
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Zip | 34134-1974
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Country | US
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Telephone | 239-703-9301
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Fax |
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Provider Business Mailing Address
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Address Line | 8353 SW 124TH ST STE 206
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City | MIAMI
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State | FL
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Zip | 33156-5847
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Country | US
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Telephone | 239-703-9301
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Fax |
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Authorized Official
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Title or Position | PODIATRIST
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Name | DR. STEPHANIE ANN FIELDS
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Credential | DPM
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Telephone | 239-404-7793
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 3984
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License Number State | FL
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