=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871644096
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SARASOTA PLASTIC SURGERY CENTER INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/15/2007
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2255 S TAMIAMI TRL
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34239-3806
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-366-8897
-----------------------------------------------------
Fax | 941-366-0518
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2255 S TAMIAMI TRL
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34239-3806
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-366-8897
-----------------------------------------------------
Fax | 941-366-0518
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO ADMINISTRATOR
-----------------------------------------------------
Name | DEVONNE MARIE LABONTE
-----------------------------------------------------
Credential | MHA, LHRM
-----------------------------------------------------
Telephone | 941-366-8897
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------