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General NPI Number Information
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NPI Number | 1346594868
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Entity Type | Organization
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Legal Business Name | SUNSHINE STATE PHYSICIANS GROUP, LLC
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Dates
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Enumeration Date | 11/06/2012
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Last Update Date | 11/06/2012
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Provider Practice Location Address
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Address Line | 9753 S ORANGE BLOSSOM TRL SUITE 103
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City | ORLANDO
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State | FL
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Zip | 32837-7841
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Country | US
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Telephone | 407-857-8679
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Fax | 407-857-8672
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Provider Business Mailing Address
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Address Line | 9753 S ORANGE BLOSSOM TRL SUITE 103
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City | ORLANDO
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State | FL
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Zip | 32837-7841
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Country | US
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Telephone | 407-857-8679
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Fax | 407-857-8672
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Authorized Official
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Title or Position | DIRECTOR OF CLINICAL OPERATIONS
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Name | MS. SANDRA LYNNE AUSTIN
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Credential | BSN, BSHA
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Telephone | 407-857-8679
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH10505
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME50492
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License Number State | FL
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