1285618512 NPI number — DR. SARA BERYL SUNDERMEYER DC

Table of content: DR. SARA BERYL SUNDERMEYER DC (NPI 1285618512)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285618512 NPI number — DR. SARA BERYL SUNDERMEYER DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SUNDERMEYER
Provider First Name:
SARA
Provider Middle Name:
BERYL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285618512
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/24/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
214 MAIN ST.
Provider Second Line Business Mailing Address:
AUBURNDALE CHIROPRACTICE, LLC
Provider Business Mailing Address City Name:
AUBURNDALE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33823
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
863-968-0088
Provider Business Mailing Address Fax Number:
863-968-0181

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
214 MAIN ST.
Provider Second Line Business Practice Location Address:
AUBURNDALE CHIROPRACTICE, LLC
Provider Business Practice Location Address City Name:
AUBURNDALE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33823
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
863-968-0088
Provider Business Practice Location Address Fax Number:
863-968-0181
Provider Enumeration Date:
11/30/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CH8530 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 381673700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: P001650077 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 118414000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com