Healthcare Provider Details

I. General information

NPI: 1023063310
Provider Name (Legal Business Name): SONSHINE MEDICAL AND SURGICAL SUPPLIES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 06/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3975 US 27 S
SEBRING FL
33870-5512
US

IV. Provider business mailing address

3975 US 27 S
SEBRING FL
33870-5512
US

V. Phone/Fax

Practice location:
  • Phone: 863-382-2606
  • Fax:
Mailing address:
  • Phone: 863-382-2606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number32:00141
License Number StateFL

VIII. Authorized Official

Name: MRS. SALENA ANN FANTETTI
Title or Position: MANAGER
Credential:
Phone: 863-382-2606