Healthcare Provider Details

I. General information

NPI: 1750763777
Provider Name (Legal Business Name): SUNSHINE CARDIOVASCULAR SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2015
Last Update Date: 04/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8695 COLLEGE PKWY
FORT MYERS FL
33919-4809
US

IV. Provider business mailing address

8695 COLLEGE PKWY
FORT MYERS FL
33919-4809
US

V. Phone/Fax

Practice location:
  • Phone: 239-823-2408
  • Fax: 877-334-9599
Mailing address:
  • Phone: 239-823-2408
  • Fax: 877-334-9599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: JEANNE BEAULIEU
Title or Position: REGISTERED AGENT
Credential:
Phone: 239-247-2118