| Lakeside Endocrine Associates, Inc | |
|
1667 N Clyde Morris Blvd Suite 2 Daytona Beach FL 32117-5500 | |
| (386) 274-1944 | |
| Not Available |
| Full Name | Lakeside Endocrine Associates, Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1667 N Clyde Morris Blvd, Daytona Beach, Florida |
| Authorized Official Name and Position | Neime O Sanchez-givens (PRESIDENT) |
| Authorized Official Contact | 3862374390 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lakeside Endocrine Associates, Inc 1667 N Clyde Morris Blvd Suite 2 Daytona Beach FL 32117-5500 Ph: (386) 274-1944 | Lakeside Endocrine Associates, Inc 1667 N Clyde Morris Blvd Suite 2 Daytona Beach FL 32117-5500 Ph: (386) 274-1944 |
| NPI Number | 1871041681 |
|---|---|
| Provider Enumeration Date | 09/21/2016 |
| Last Update Date | 08/15/2023 |
| Medicare PECOS PAC ID | 9133408008 |
|---|---|
| Medicare Enrollment ID | O20161116002444 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871041681 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RE0101X | Internal Medicine - Endocrinology, Diabetes & Metabolism | (* (Not Available)) | Primary |
| Provider Name | Sherida Ann Hahn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508218454 PECOS PAC ID: 2860775673 Enrollment ID: I20170201001529 |
| Provider Name | Frank Robert Kohler |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1356432090 PECOS PAC ID: 6608948336 Enrollment ID: I20170321002204 |
| Provider Name | Christopher Dylan Chambliss |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801489497 PECOS PAC ID: 0547676629 Enrollment ID: I20210316000924 |
| Provider Name | Ashley Suzanne Pease |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326610544 PECOS PAC ID: 3779979141 Enrollment ID: I20220412001264 |
| Provider Name | Shawn Demian Kelly |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174831093 PECOS PAC ID: 3779723655 Enrollment ID: I20240129001494 |
| Provider Name | Tamara S Michael |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982741724 PECOS PAC ID: 3971587957 Enrollment ID: I20240320001476 |
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