Basic Information
| Provider Information | |||||||||
| NPI: | 1205172079 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUNBELT ANESTHESIA SERVICES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 25801 | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336225801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8888514642 | ||||||||
| FaxNumber: | 2403423837 | ||||||||
| Practice Location | |||||||||
| Address1: | 690 MAJESTIC EAGLE DR | ||||||||
| Address2: | |||||||||
| City: | PONTE VEDRA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320810611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9044122593 | ||||||||
| FaxNumber: | 8666336132 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2012 | ||||||||
| LastUpdateDate: | 07/19/2022 | ||||||||
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| AuthorizedOfficialLastName: | KALYNYCH | ||||||||
| AuthorizedOfficialFirstName: | NICHOLAS | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGING MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 9044122593 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CRNA | ||||||||
| NPICertificationDate: | 07/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 207L00000X | FL | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.