Provider Demographics
NPI:1942054689
Name:SUNSHINE FOOT AND ANKLE LLC
Entity Type:Organization
Organization Name:SUNSHINE FOOT AND ANKLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLLINEDA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:786-566-1272
Mailing Address - Street 1:2951 NW 49TH AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33313-1608
Mailing Address - Country:US
Mailing Address - Phone:754-296-5900
Mailing Address - Fax:
Practice Address - Street 1:2951 NW 49TH AVE STE 204
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33313-1608
Practice Address - Country:US
Practice Address - Phone:754-296-5900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty