Provider Demographics
NPI:1841735867
Name:SUNCOAST BREAST RESTORATION PLLC
Entity Type:Organization
Organization Name:SUNCOAST BREAST RESTORATION PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:AMBAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-563-1144
Mailing Address - Street 1:403 LITHIA PINECREST RD
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-6138
Mailing Address - Country:US
Mailing Address - Phone:813-563-1144
Mailing Address - Fax:
Practice Address - Street 1:403 LITHIA PINECREST RD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-6138
Practice Address - Country:US
Practice Address - Phone:813-563-1144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-29
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty