MEDICARE: SUNCOAST VEIN & VASCULAR CLINIC PLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0204X	Vascular & Interventional Radiology Physician	ME81395	FL

General Provider Information

NPI Number	:	1750564696
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNCOAST VEIN & VASCULAR CLINIC PLC

Provider Business Mailing Address
First Line	:	1728 DUNLAWTON AVE
Second Line	:	STE 5
City	:	PORT ORANGE
State	:	FL
Zip	:	32127-2922
Country	:	US
Telephone Number	:	386-304-3404
Fax Number	:	386-304-3135

Provider Business Practice Location Address
First Line	:	1728 DUNLAWTON AVE
Second Line	:	STE 5
City	:	PORT ORANGE
State	:	FL
Zip	:	32127-2922
Country	:	US
Telephone Number	:	386-304-3404
Fax Number	:

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	MRS. SWAPNA SINGIREDDY
Credential	:
Telephone Number	:	386-235-9677

Provider Enumeration Date	:	12/14/2007
Last Update Date	:	08/09/2016

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