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General NPI Number Information
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NPI Number | 1750564696
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Entity Type | Organization
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Legal Business Name | SUNCOAST VEIN & VASCULAR CLINIC PLC
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Dates
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Enumeration Date | 12/14/2007
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Last Update Date | 08/09/2016
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Provider Practice Location Address
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Address Line | 1728 DUNLAWTON AVE STE 5
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City | PORT ORANGE
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State | FL
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Zip | 32127-2922
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Country | US
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Telephone | 386-304-3404
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Fax |
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Provider Business Mailing Address
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Address Line | 1728 DUNLAWTON AVE STE 5
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City | PORT ORANGE
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State | FL
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Zip | 32127-2922
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Country | US
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Telephone | 386-304-3404
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Fax | 386-304-3135
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MRS. SWAPNA SINGIREDDY
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Credential |
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Telephone | 386-235-9677
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | ME81395
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License Number State | FL
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