Provider Demographics
NPI:1780862094
Name:SUNSTATEMEDICAL ASSOCIATES PA
Entity Type:Organization
Organization Name:SUNSTATEMEDICAL ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NERICELY
Authorized Official - Middle Name:M
Authorized Official - Last Name:CASADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-333-3303
Mailing Address - Street 1:758 N SUN DR STE 104
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-2599
Mailing Address - Country:US
Mailing Address - Phone:407-333-3303
Mailing Address - Fax:407-333-3342
Practice Address - Street 1:758 N SUN DR STE 104
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-2599
Practice Address - Country:US
Practice Address - Phone:407-333-3303
Practice Address - Fax:407-333-3342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-08
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK0884Medicare PIN