Organization
BAYSIDE HEALTHCARE BRANDON, INC
Active
Other names
Suncoast Total Healthcare
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KEVIN DONOFRIO (PRESIDENT)
(813) 654-1856
Entity
Organization
Contact information
Practice address
615 VONDERBURG DR, BRANDON, FL 33511-5972
(813) 654-1856
(813) 681-7268
Mailing address
1903 W LUMSDEN RD, BRANDON, FL 33511-8818
(813) 654-1856
(813) 681-7268
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
HCC6754
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
HCC6754
LICENSE NUMBER
FL
Enumeration date
08/06/2007
Last updated
08/06/2007
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