Provider Demographics
NPI:1598266850
Name:SUNSHINE BEHAVIORAL MEDICINE INC
Entity Type:Organization
Organization Name:SUNSHINE BEHAVIORAL MEDICINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIUMARS
Authorized Official - Middle Name:E
Authorized Official - Last Name:SHAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-360-4147
Mailing Address - Street 1:PO BOX 186
Mailing Address - Street 2:
Mailing Address - City:GRACEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32440-0186
Mailing Address - Country:US
Mailing Address - Phone:850-360-4147
Mailing Address - Fax:850-360-4068
Practice Address - Street 1:5389 COTTON ST
Practice Address - Street 2:
Practice Address - City:GRACEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32440-1739
Practice Address - Country:US
Practice Address - Phone:850-360-4147
Practice Address - Fax:850-360-4068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-22
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty