=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578210217
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SON SHINE HEALTH AND WELLNESS CENTER, PSC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/02/2022
-----------------------------------------------------
Last Update Date | 09/11/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 305 MORTON BLVD
-----------------------------------------------------
City | HAZARD
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41701-9418
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-216-2599
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 305 MORTON BLVD
-----------------------------------------------------
City | HAZARD
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41701-9418
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-436-0514
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PROVIDER
-----------------------------------------------------
Name | DR. VERONICA LINDSEY CAUDILL-ENGLE
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 606-216-2599
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------