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General NPI Number Information
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NPI Number | 1942584172
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Entity Type | Organization
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Legal Business Name | SUNNY ISLES MEDICAL CLINIC
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Dates
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Enumeration Date | 10/06/2011
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Last Update Date | 10/06/2011
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Provider Practice Location Address
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Address Line | 17395 N BAY RD STE 200
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City | SUNNY ISLES BEACH
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State | FL
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Zip | 33160-3334
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Country | US
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Telephone | 305-974-0430
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Fax |
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Provider Business Mailing Address
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Address Line | 17395 N BAY RD STE 200
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City | SUNNY ISLES BEACH
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State | FL
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Zip | 33160-3334
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Country | US
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Telephone | 305-974-0430
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MRS. ZHANNA ZITSBANK
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Credential | PA-C
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Telephone | 305-974-0430
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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