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General NPI Number Information
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NPI Number | 1063207967
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Entity Type | Organization
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Legal Business Name | SUNSHINE STATE WELLNESS
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Dates
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Enumeration Date | 04/11/2025
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Last Update Date | 04/11/2025
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Provider Practice Location Address
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Address Line | 500 SHOTGUN RD
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City | SUNRISE
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State | FL
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Zip | 33326-1903
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Country | US
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Telephone | 561-501-2391
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Fax |
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Provider Business Mailing Address
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Address Line | 2828 S SEACREST BLVD STE 213A
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City | BOYNTON BEACH
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State | FL
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Zip | 33435-7944
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Country | US
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Telephone | 561-501-2391
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Fax |
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Authorized Official
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Title or Position | PRES
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Name | KENT MCNEAL
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Credential |
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Telephone | 561-501-2391
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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