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General NPI Number Information
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NPI Number | 1184854176
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Entity Type | Organization
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Legal Business Name | SUNSHINE STATE PEDIATRICS OF CENTRAL FLORIDA INC
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Dates
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Enumeration Date | 07/23/2009
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Last Update Date | 08/31/2012
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Provider Practice Location Address
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Address Line | 8000 RED BUG LAKE RD STE 280
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City | OVIEDO
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State | FL
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Zip | 32765-9267
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Country | US
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Telephone | 407-977-1234
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Fax | 407-977-1235
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Provider Business Mailing Address
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Address Line | PO BOX 623747
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City | OVIEDO
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State | FL
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Zip | 32762-3747
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Country | US
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Telephone | 407-977-1234
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Fax | 407-977-1235
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Authorized Official
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Title or Position | OWNER
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Name | MS. SHANNA NICOLE KOVACS
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Credential | RN
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Telephone | 407-977-1234
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 96797
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License Number State | FL
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