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General NPI Number Information
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NPI Number | 1710140942
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Entity Type | Organization
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Legal Business Name | PARADISE PEDIATRICS, PL
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Dates
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Enumeration Date | 07/08/2008
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Last Update Date | 07/11/2008
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Provider Practice Location Address
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Address Line | 4411 BEE RIDGE RD #419
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City | SARASOTA
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State | FL
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Zip | 34233-2514
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Country | US
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Telephone | 941-284-3061
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Fax | 941-981-1463
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Provider Business Mailing Address
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Address Line | 4411 BEE RIDGE RD #419
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City | SARASOTA
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State | FL
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Zip | 34233-2514
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Country | US
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Telephone | 941-284-3061
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Fax | 941-981-1463
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Authorized Official
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Title or Position | OWNER
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Name | SUZANNE SOUTHERLAND
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Credential | M.D.
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Telephone | 941-284-3061
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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 | ME78267
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License Number State | FL
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