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General NPI Number Information
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NPI Number | 1871267625
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Entity Type | Organization
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Legal Business Name | ST. LUCIE ANESTHESIA ASSOCIATES LLC
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Dates
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Enumeration Date | 08/05/2021
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Last Update Date | 06/30/2022
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Provider Practice Location Address
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Address Line | 555 SE 5TH AVE
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City | DELRAY BEACH
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State | FL
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Zip | 33483-5212
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Country | US
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Telephone | 877-328-1119
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Fax |
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Provider Business Mailing Address
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Address Line | 5565 CENTERVIEW DR STE 107
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City | RALEIGH
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State | NC
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Zip | 27606-3563
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OFFICER
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Name | KATHY KONDAS
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Credential |
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Telephone | 877-328-1119
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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