Provider Demographics
NPI:1457020646
Name:SUNNYSIDE MENTAL HEALTH LLC
Entity Type:Organization
Organization Name:SUNNYSIDE MENTAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEMIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:EXPOSITO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-846-9333
Mailing Address - Street 1:381 N KROME AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-6047
Mailing Address - Country:US
Mailing Address - Phone:305-846-9333
Mailing Address - Fax:
Practice Address - Street 1:381 N KROME AVE STE 104
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-6047
Practice Address - Country:US
Practice Address - Phone:305-810-9718
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health