Provider Demographics
NPI:1952974719
Name:SUNSHINE KIDS PEDIATRIC CARE, LLC, FLL, THERAPY
Entity Type:Organization
Organization Name:SUNSHINE KIDS PEDIATRIC CARE, LLC, FLL, THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:MAYMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-881-8230
Mailing Address - Street 1:2122 NW 62ND ST STE 103
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-1866
Mailing Address - Country:US
Mailing Address - Phone:954-881-8230
Mailing Address - Fax:
Practice Address - Street 1:2122 NW 62ND ST STE 103
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-1866
Practice Address - Country:US
Practice Address - Phone:954-881-8230
Practice Address - Fax:954-892-6567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-20
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center