=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548528722
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUNSHINE PSCHIATRIC ASSOCIATES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/25/2012
-----------------------------------------------------
Last Update Date | 04/25/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12760 FRANK DR. N.
-----------------------------------------------------
City | SEMINOLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33776-1720
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-517-3415
-----------------------------------------------------
Fax | 727-216-8960
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8250 BRYAN DAIRY RD SUITE 110
-----------------------------------------------------
City | LARGO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33777-1353
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-776-8691
-----------------------------------------------------
Fax | 727-216-8960
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | RICHARD ALLEN COTTRELL
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 727-776-8691
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | OS 8173
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------