Provider Demographics
NPI:1164746665
Name:SUNSHINE HEALTHCARE SOLUTIONS OF BREVARD LLC
Entity Type:Organization
Organization Name:SUNSHINE HEALTHCARE SOLUTIONS OF BREVARD LLC
Other - Org Name:SUNSHINE HEALTHCARE SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PITCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-693-2977
Mailing Address - Street 1:660 PLANTATION RD
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952-4035
Mailing Address - Country:US
Mailing Address - Phone:321-693-2977
Mailing Address - Fax:866-610-1917
Practice Address - Street 1:465 MINUTEMEN CSWY
Practice Address - Street 2:SUITE 455
Practice Address - City:COCOA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32931-2881
Practice Address - Country:US
Practice Address - Phone:866-389-7601
Practice Address - Fax:866-610-1917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-26
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Multi-Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLEX515AOtherPTAN