Provider Demographics
NPI:1104115096
Name:SUNSHINE WELLNESS, INC.
Entity type:Organization
Organization Name:SUNSHINE WELLNESS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUNNY
Authorized Official - Middle Name:
Authorized Official - Last Name:LAVALLE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, LD/N
Authorized Official - Phone:305-944-4525
Mailing Address - Street 1:17251 NE 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-2209
Mailing Address - Country:US
Mailing Address - Phone:305-948-2332
Mailing Address - Fax:305-948-6627
Practice Address - Street 1:17251 NE 19TH AVE
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-2209
Practice Address - Country:US
Practice Address - Phone:305-944-4525
Practice Address - Fax:305-948-6627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-31
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND4585133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty