Healthcare Provider Details

I. General information

NPI: 1164746665
Provider Name (Legal Business Name): SUNSHINE HEALTHCARE SOLUTIONS OF BREVARD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2010
Last Update Date: 08/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 MINUTEMEN CSWY SUITE 455
COCOA BEACH FL
32931-2881
US

IV. Provider business mailing address

660 PLANTATION RD
MERRITT ISLAND FL
32952-4035
US

V. Phone/Fax

Practice location:
  • Phone: 866-389-7601
  • Fax: 866-610-1917
Mailing address:
  • Phone: 321-693-2977
  • Fax: 866-610-1917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL PITCHER
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 321-693-2977