Provider Demographics
NPI:1568428225
Name:SWITLYK, STEPHEN A (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:A
Last Name:SWITLYK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1921 WALDEMERE ST
Mailing Address - Street 2:SUITE 509
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-2943
Mailing Address - Country:US
Mailing Address - Phone:941-953-9955
Mailing Address - Fax:941-953-9933
Practice Address - Street 1:1921 WALDEMERE ST
Practice Address - Street 2:SUITE 509
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2943
Practice Address - Country:US
Practice Address - Phone:941-953-9955
Practice Address - Fax:941-953-9933
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-21
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88297207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL02045OtherUNIVERSAL HEALTHCARE
FL71349OtherBCBS
FL71349EOtherBCBS
FL203981924OtherTAX ID
FL295577OtherAVMED
FLP00171065OtherMEDICARE RR (TAMPA)
FL02045OtherUNIVERSAL HEALTHCARE
FL203981924OtherTAX ID
FL295577OtherAVMED