=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861791683
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUNSHINE PODIATRY PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/18/2011
-----------------------------------------------------
Last Update Date | 05/11/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | AVENUE P MEDICAL CENTER 209 AVENUE P, 3A
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-259-6666
-----------------------------------------------------
Fax | 718-259-7000
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | AVENUE P MEDICAL CENTER 209 AVENUE P
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-259-6666
-----------------------------------------------------
Fax | 718-259-7000
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. TERENCE M SAADVANDI
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 718-259-6666
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | 005475
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------