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General NPI Number Information
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NPI Number | 1942640057
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Entity Type | Organization
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Legal Business Name | NEWSOME MEDICAL LLC
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Dates
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Enumeration Date | 07/03/2013
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Last Update Date | 07/21/2014
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Provider Practice Location Address
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Address Line | 121 WEBB DR SUITE 100
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City | DAVENPORT
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State | FL
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Zip | 33837-3904
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Country | US
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Telephone | 863-422-0001
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Fax | 863-422-0003
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Provider Business Mailing Address
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Address Line | 121 WEBB DR SUITE 100
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City | DAVENPORT
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State | FL
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Zip | 33837-3904
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Country | US
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Telephone | 863-422-0001
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Fax | 863-422-0003
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. LADAPO O SHYNGLE
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Credential | MD
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Telephone | 863-422-0001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | ME 94349
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License Number State | FL
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