Provider Demographics
NPI:1245788595
Name:BANANA WIND MEDICAL GROUP, L.L.C
Entity Type:Organization
Organization Name:BANANA WIND MEDICAL GROUP, L.L.C
Other - Org Name:DYNAMIK HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF NURSING
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SHAVER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:321-315-3601
Mailing Address - Street 1:35 W PINE ST
Mailing Address - Street 2:SUITE 218
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-2610
Mailing Address - Country:US
Mailing Address - Phone:407-259-8731
Mailing Address - Fax:
Practice Address - Street 1:11335 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32836-6216
Practice Address - Country:US
Practice Address - Phone:407-259-8731
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-15
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9246384251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health