Healthcare Provider Details

I. General information

NPI: 1952800328
Provider Name (Legal Business Name): AH SUNSHINEENTERPRISES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2018
Last Update Date: 02/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6735 CONROY RD STE 326
ORLANDO FL
32835-3568
US

IV. Provider business mailing address

6735 CONROY RD STE 326
ORLANDO FL
32835-3568
US

V. Phone/Fax

Practice location:
  • Phone: 407-614-6255
  • Fax:
Mailing address:
  • Phone: 407-614-6255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. LISETT GONZALEZ
Title or Position: OFFICE MANAGEMENT
Credential:
Phone: 407-614-6255