# SON SHINE FOOT AND ANKLE CENTER INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063459675
- **Authorized official:** DR. ALBERT ANDREW DERRICO DPM (PHYSICIAN)
- **Authorized official phone:** (772) 380-0900

## Contact information

- **Practice address:** 1405 SE GOLDTREE DR, SUITE B, PORT ST LUCIE, FL 34952-7563
- **Practice address phone:** (772) 380-0900
- **Practice address fax:** (772) 380-0901
- **Mailing address:** PO BOX 8210, PORT ST LUCIE, FL 34985-8210
- **Mailing address phone:** (772) 380-0900
- **Mailing address fax:** (772) 380-0901

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | PO2649 | FL | Yes |

## Other

- **Enumeration date:** 06/01/2006
- **Last updated:** 01/03/2008