Healthcare Provider Details

I. General information

NPI: 1316523640
Provider Name (Legal Business Name): SUNNYSIDE MENTAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2021
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1490 W 49TH PL STE 309
HIALEAH FL
33012-8131
US

IV. Provider business mailing address

1490 W 49TH PL STE 309
HIALEAH FL
33012-8131
US

V. Phone/Fax

Practice location:
  • Phone: 305-333-3333
  • Fax:
Mailing address:
  • Phone: 305-843-9333
  • Fax: 786-567-4764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: YUSELIS TITO AMADOR
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 305-497-0977