Provider Demographics
NPI:1831485093
Name:FWC PERINATAL, LLC
Entity Type:Organization
Organization Name:FWC PERINATAL, LLC
Other - Org Name:FWC PERINATAL, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:SUDBURY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-300-2410
Mailing Address - Street 1:PO BOX 5558
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-5500
Mailing Address - Country:US
Mailing Address - Phone:561-300-2410
Mailing Address - Fax:561-235-7292
Practice Address - Street 1:1501 YAMATO ROAD
Practice Address - Street 2:SUITE 200 WEST
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431
Practice Address - Country:US
Practice Address - Phone:561-300-2410
Practice Address - Fax:561-235-7292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-24
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Multi-Specialty