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General NPI Number Information
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NPI Number | 1912202714
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Entity Type | Organization
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Legal Business Name | SUNSHINE MEDICAL NETWORK
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Dates
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Enumeration Date | 01/26/2011
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Last Update Date | 02/08/2011
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Provider Practice Location Address
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Address Line | 5341 RUBY LN
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City | SARASOTA
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State | FL
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Zip | 34231-6225
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Country | US
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Telephone | 941-504-6183
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Fax | 941-922-6571
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Provider Business Mailing Address
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Address Line | 5341 RUBY LN
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City | SARASOTA
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State | FL
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Zip | 34231-6225
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Country | US
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Telephone | 941-504-6183
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Fax | 941-922-6571
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Authorized Official
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Title or Position | PRESIDENT CEO
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Name | DR. MARYNA NIKOLAYEVNA ROBERTS
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Credential | M.D.
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Telephone | 941-504-6183
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | ME106791
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License Number State | FL
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