Organization
BAYSIDE HEALTHCARE BRANDON INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KEVIN DONOFRIO (PRESIDENT)
(813) 654-6568
Entity
Organization
Contact information
Practice address
615 VONDERBURG DR, BRANDON, FL 33511-5972
(813) 654-1856
(813) 681-7268
Mailing address
615 VONDERBURG DR, BRANDON, FL 33511-5972
(813) 654-1856
(813) 681-7268
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
HCC6754
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
HCC6754
STATE LICENSE
FL
Enumeration date
12/07/2007
Last updated
12/07/2007
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