Basic Information
| Provider Information | |||||||||
| NPI: | 1184819567 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SUNSHINE STATE SURGERY P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 266 S MOON AVE | ||||||||
| Address2: | |||||||||
| City: | BRANDON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335115711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8136554700 | ||||||||
| FaxNumber: | 8003031247 | ||||||||
| Practice Location | |||||||||
| Address1: | 266 S MOON AVE | ||||||||
| Address2: | |||||||||
| City: | BRANDON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335115711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8136554700 | ||||||||
| FaxNumber: | 8003031247 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/10/2007 | ||||||||
| LastUpdateDate: | 09/10/2007 | ||||||||
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| AuthorizedOfficialLastName: | BHATT | ||||||||
| AuthorizedOfficialFirstName: | VYOMESH | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | BILLING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8134255826 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | ME91900 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.