Healthcare Provider Details

I. General information

NPI: 1053137695
Provider Name (Legal Business Name): SUNSHINE WELLNESS CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2024
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 SE JOHNSON AVE STE LH
STUART FL
34994-3816
US

IV. Provider business mailing address

2404 NE PALM AVE
JENSEN BEACH FL
34957-5246
US

V. Phone/Fax

Practice location:
  • Phone: 772-453-1072
  • Fax: 772-510-4229
Mailing address:
  • Phone: 772-453-1072
  • Fax: 772-510-4229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: TROY JOSEPH GOLDENBERG
Title or Position: PROVIDER
Credential: AP
Phone: 772-453-1072