Healthcare Provider Details

I. General information

NPI: 1285915603
Provider Name (Legal Business Name): SUNSHINE PEDIATRICS OF OCALA PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2011
Last Update Date: 08/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 SW 20TH PL
OCALA FL
34471
US

IV. Provider business mailing address

1900 SW 20TH PL
OCALA FL
34471-7870
US

V. Phone/Fax

Practice location:
  • Phone: 352-840-5437
  • Fax: 352-237-1094
Mailing address:
  • Phone: 352-840-5437
  • Fax: 352-237-1094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME76333
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. MADHUKAR SHRINATH
Title or Position: OWNER
Credential: M.D.
Phone: 352-840-5437