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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
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
213E00000X
Podiatrist

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
277020200
FL
01
99767
BCBS
FL
Enumeration date
04/11/2006
Last updated
01/15/2024
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