Provider Demographics
NPI:1770653107
Name:SUNSHINE MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:SUNSHINE MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SOORDAL
Authorized Official - Middle Name:O
Authorized Official - Last Name:PRAKASH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-918-2011
Mailing Address - Street 1:5937 BENEVA RD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34238-2504
Mailing Address - Country:US
Mailing Address - Phone:941-918-2011
Mailing Address - Fax:941-918-2046
Practice Address - Street 1:5937 BENEVA RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34238-2504
Practice Address - Country:US
Practice Address - Phone:941-918-2011
Practice Address - Fax:941-918-2046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME76860174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL34412OtherBCBS OF FLORIDA
FL269352600Medicaid
FLDA2494OtherRAILROAD MEDICARE
FL7119242OtherAETNA
FLK3680Medicare ID - Type UnspecifiedGROUP NUMBER