{
"Npi": {
"NPI": "1548528722",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SUNSHINE PSCHIATRIC ASSOCIATES, LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "8250 BRYAN DAIRY RD",
"SecondLineMailingAddress": "SUITE 110",
"MailingAddressCityName": "LARGO",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33777-1353",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "727-776-8691",
"MailingAddressFaxNumber": "727-216-8960",
"FirstLinePracticeLocationAddress": "12760 FRANK DR. N.",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SEMINOLE",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33776-1720",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "727-517-3415",
"PracticeLocationAddressFaxNumber": "727-216-8960",
"EnumerationDate": "04/25/2012",
"LastUpdateDate": "04/25/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "COTTRELL",
"AuthorizedOfficialFirstName": "RICHARD",
"AuthorizedOfficialMiddleName": "ALLEN",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DO",
"AuthorizedOfficialTelephoneNumber": "727-776-8691",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "2084P0800X",
"TaxonomyName": "Psychiatry Physician",
"LicenseNumber": "OS 8173",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}