Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | AL4592 | FL |
Y | 213ES0000X | Sports Medicine | AL4592 | FL |
NPI | 1265926703 |
---|---|
Provider Name | Shana Sunseri |
First Address | Saint Johns, FL 32259-1935 |
Second Address | Tampa, FL 33607-5701 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2018 |
Last Update Date | 19/06/2018 |