Provider Demographics
NPI:1811594153
Name:SUNSHINE WELLNESS GROUP LLC
Entity Type:Organization
Organization Name:SUNSHINE WELLNESS GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOEAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:MAZHIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-827-0666
Mailing Address - Street 1:PO BOX 5
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32756-0005
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8464 W AQUADUCT ST
Practice Address - Street 2:
Practice Address - City:HOMOSASSA
Practice Address - State:FL
Practice Address - Zip Code:34448-2724
Practice Address - Country:US
Practice Address - Phone:936-827-0666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-08
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center