Provider Demographics
NPI:1386689057
Name:SUNSHINE PEDIATRICS
Entity Type:Organization
Organization Name:SUNSHINE PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAFAH
Authorized Official - Middle Name:
Authorized Official - Last Name:AFLAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-478-5440
Mailing Address - Street 1:185 CROSSVILLE ST
Mailing Address - Street 2:
Mailing Address - City:CANTONMENT
Mailing Address - State:FL
Mailing Address - Zip Code:32533-6586
Mailing Address - Country:US
Mailing Address - Phone:850-478-5440
Mailing Address - Fax:850-478-5447
Practice Address - Street 1:185 CROSSVILLE ST
Practice Address - Street 2:
Practice Address - City:CANTONMENT
Practice Address - State:FL
Practice Address - Zip Code:32533-6586
Practice Address - Country:US
Practice Address - Phone:850-478-5440
Practice Address - Fax:850-478-5447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL258104300Medicaid