Healthcare Provider Details

I. General information

NPI: 1801638556
Provider Name (Legal Business Name): SUNSHINE MEDICAL MANAGEMENT ADVISORS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2024
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14665 CANOPY DR
TAMPA FL
33626-3354
US

IV. Provider business mailing address

14665 CANOPY DR
TAMPA FL
33626-3354
US

V. Phone/Fax

Practice location:
  • Phone: 813-843-5680
  • Fax:
Mailing address:
  • Phone: 813-843-5680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARK ORDEMAN
Title or Position: FOUNDER
Credential:
Phone: 813-810-7625