Provider Demographics
NPI:1154577021
Name:SUNDARI PLASTICS LLC
Entity type:Organization
Organization Name:SUNDARI PLASTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:BARRY
Authorized Official - Last Name:ROACH
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:727-378-5808
Mailing Address - Street 1:PO BOX 5441
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34674-5441
Mailing Address - Country:US
Mailing Address - Phone:727-378-5808
Mailing Address - Fax:727-378-5810
Practice Address - Street 1:14100 FIVAY RD
Practice Address - Street 2:SUITE 130
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-7180
Practice Address - Country:US
Practice Address - Phone:727-378-5808
Practice Address - Fax:727-378-5810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-12
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS95662086S0122X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty