Provider Demographics
NPI:1154573384
Name:SCULPSIT PLASTIC SURGERY PA
Entity type:Organization
Organization Name:SCULPSIT PLASTIC SURGERY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLFORT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-477-7458
Mailing Address - Street 1:1118 GULF BREEZE PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32561-7800
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1118 GULF BREEZE PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32561-7800
Practice Address - Country:US
Practice Address - Phone:800-477-7458
Practice Address - Fax:850-435-8352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME102994208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty