Organization
SOVEREIGN PLASTIC SURGERY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALISSA M SHULMAN MD (OWNER)
(941) 366-5476
Entity
Organization
Contact information
Practice address
1950 ARLINGTON ST, SUITE 112, SARASOTA, FL 34239-3508
(941) 366-5476
(941) 866-7388
Mailing address
1950 ARLINGTON ST, SUITE 112, SARASOTA, FL 34239-3508
(941) 366-5476
(941) 866-7388
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
ME103128
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BI1647
MEDICARE PTAN
FL
01
—
DO9595
MEDICARE RAILROAD PTAN
FL
01
—
ME103128
FLORIDA MEDICAL LICENSE
FL
Enumeration date
11/04/2008
Last updated
10/12/2012
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