Healthcare Provider Details

I. General information

NPI: 1124273529
Provider Name (Legal Business Name): SUNSHINE SPINE AND PAIN, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2008
Last Update Date: 04/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 SHIRCLIFF WAY SUITE 610
JACKSONVILLE FL
32204-4757
US

IV. Provider business mailing address

PO BOX 919327
ORLANDO FL
32891-9327
US

V. Phone/Fax

Practice location:
  • Phone: 904-292-2700
  • Fax:
Mailing address:
  • Phone: 904-292-2700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberME84002
License Number StateFL

VIII. Authorized Official

Name: TERESA FRIEDLEY
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 904-292-2700