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Organization
ANASTASIA MEDICAL GROUP, LLC
Active
Organization
ANASTASIA MEDICAL GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUHAS P NEERUKONDA MD (MANAGING PARTNER)
(904) 461-0343
Entity
Organization
Contact information
Practice address
1301 PLANTATION ISLAND DRIVE, SUITE 203A, ST AUGUSTINE, FL 32080
(904) 461-0821
(904) 461-0823
Mailing address
1301 PLANTATION ISLAND DRIVE, SUITE 203A, ST AUGUSTINE, FL 32080
(904) 461-0821
(904) 461-0823
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
NULL
207R00000X
Internal Medicine Physician
Primary
—
—
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
—
NULL
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
—
—
213E00000X
Podiatrist
—
NULL
213E00000X
Podiatrist
—
—
Other
Enumeration date
04/11/2006
Last updated
01/15/2024
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