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General NPI Number Information
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NPI Number | 1235174095
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Entity Type | Organization
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Legal Business Name | SUNSHINE FAMILY HEALTHCARE, LLC
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Dates
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Enumeration Date | 06/17/2006
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Last Update Date | 04/12/2021
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Provider Practice Location Address
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Address Line | 21 HOSPITAL DR STE 280
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City | PALM COAST
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State | FL
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Zip | 32164-2456
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Country | US
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Telephone | 386-986-6808
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Fax | 386-986-6818
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Provider Business Mailing Address
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Address Line | 21 HOSPITAL DR STE 280
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City | PALM COAST
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State | FL
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Zip | 32164-2456
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Country | US
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Telephone | 386-986-6808
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Fax | 386-986-6818
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Authorized Official
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Title or Position | OWNER / PHYSICIAN
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Name | DR. JERRY DALE LEVENTHAL
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Credential | MD
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Telephone | 386-986-6808
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | FL
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