Provider Demographics
NPI:1205172079
Name:SUNBELT ANESTHESIA SERVICES, LLC
Entity type:Organization
Organization Name:SUNBELT ANESTHESIA SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:KALYNYCH
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:904-412-2593
Mailing Address - Street 1:PO BOX 25801
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33622-5801
Mailing Address - Country:US
Mailing Address - Phone:888-851-4642
Mailing Address - Fax:240-342-3837
Practice Address - Street 1:690 MAJESTIC EAGLE DR
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA
Practice Address - State:FL
Practice Address - Zip Code:32081-0611
Practice Address - Country:US
Practice Address - Phone:904-412-2593
Practice Address - Fax:866-633-6132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-21
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
367500000X
FL207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty