Healthcare Provider Details

I. General information

NPI: 1386689057
Provider Name (Legal Business Name): SUNSHINE PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 05/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 CROSSVILLE ST
CANTONMENT FL
32533-6586
US

IV. Provider business mailing address

185 CROSSVILLE ST
CANTONMENT FL
32533-6586
US

V. Phone/Fax

Practice location:
  • Phone: 850-478-5440
  • Fax: 850-478-5447
Mailing address:
  • Phone: 850-478-5440
  • Fax: 850-478-5447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: RAFAH AFLAK
Title or Position: PROVIDER/OWNER
Credential: M.D.
Phone: 850-478-5440