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General NPI Number Information
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NPI Number | 1336780907
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Entity Type | Organization
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Legal Business Name | SUNSHINE MEDICAL SPECIALISTS, LLC
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Dates
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Enumeration Date | 10/03/2019
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Last Update Date | 04/01/2020
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Provider Practice Location Address
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Address Line | 10175 FORTUNE PKWY
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City | JACKSONVILLE
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State | FL
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Zip | 32256-6746
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Country | US
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Telephone | 904-533-6868
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Fax |
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Provider Business Mailing Address
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Address Line | 1334 N KYLE WAY
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City | SAINT JOHNS
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State | FL
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Zip | 32259-1927
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Country | US
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Telephone | 904-533-6868
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Fax | 904-770-4003
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Authorized Official
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Title or Position | OWNER
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Name | THANH NGUYEN
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Credential | MD
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Telephone | 904-533-6868
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0205X
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Taxonomy Name | Pediatric Endocrinology Physician
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License Number |
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License Number State |
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