| Organization Name: | SON SHINE FOOT AND ANKLE CENTER INC |
| NPI Number: | 1063459675 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ALBERT ANDREW DERRICO (PHYSICIAN) |
| Mailing Address: | 1405 Se Goldtree Dr Suite B Port St Lucie |
| State: | FL US |
| Postal Code: | 349527563 |
| Phone Number: | 7723800900 |
| Fax Number: | 7723800901 |
| NPI Enumeration Date: | 06/01/2006 |
| NPI Last Update Date: | 01/03/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0103X |
| License Number: | PO2649 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot & Ankle Surgery |
| Taxonomy Definition: | |