=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720385362
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STEVEN D. FAYNE, M.D. P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/17/2011
-----------------------------------------------------
Last Update Date | 02/17/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8890 W OAKLAND PARK BLVD 100
-----------------------------------------------------
City | SUNRISE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33351-7235
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-741-3305
-----------------------------------------------------
Fax | 954-741-3306
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8890 W OAKLAND PARK BLVD 100
-----------------------------------------------------
City | SUNRISE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33351-7235
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-741-3305
-----------------------------------------------------
Fax | 954-741-3306
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | SHAWN BRADLEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 954-741-3305
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | ME0042650
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------