Provider Demographics
NPI:1134368426
Name:SUNSHINE STATE ANESTHESIA ASSOCIATES P.L.
Entity type:Organization
Organization Name:SUNSHINE STATE ANESTHESIA ASSOCIATES P.L.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SIDHOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-731-0416
Mailing Address - Street 1:P.O. BOX 10390
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34603
Mailing Address - Country:US
Mailing Address - Phone:352-688-6393
Mailing Address - Fax:352-688-1113
Practice Address - Street 1:5193 MARINER BLVD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34609
Practice Address - Country:US
Practice Address - Phone:352-688-6393
Practice Address - Fax:352-688-1113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCC704BMedicare UPIN