Healthcare Provider Details

I. General information

NPI: 1497665400
Provider Name (Legal Business Name): SUNCOAST OPTIMAL WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 HARBOR VILLAGE LN
APOLLO BEACH FL
33572-3424
US

IV. Provider business mailing address

230 HARBOR VILLAGE LN
APOLLO BEACH FL
33572-3424
US

V. Phone/Fax

Practice location:
  • Phone: 813-645-2003
  • Fax: 813-645-2007
Mailing address:
  • Phone: 813-645-2003
  • Fax: 813-645-2007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. MARK SLUSHER
Title or Position: CO-OWNER
Credential:
Phone: 813-645-2003