Provider Demographics
NPI:1811701857
Name:SUNSHINE MEDICAL AND WELLNESS PRACTICE LLC
Entity type:Organization
Organization Name:SUNSHINE MEDICAL AND WELLNESS PRACTICE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:PIDUGU
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:305-778-8725
Mailing Address - Street 1:6765 SUNSET STRIP STE 6
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33313-2894
Mailing Address - Country:US
Mailing Address - Phone:954-572-7756
Mailing Address - Fax:954-572-7799
Practice Address - Street 1:6765 SUNSET STRIP STE 6
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33313-2894
Practice Address - Country:US
Practice Address - Phone:954-572-7756
Practice Address - Fax:954-572-7799
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUNSHINE MEDICAL AND WELLNESS PRACTICE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-02-01
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care