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General NPI Number Information
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NPI Number | 1669123113
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Entity Type | Organization
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Legal Business Name | SUNSHINE INTERVENTIONAL PAIN AND WELLNESS CENTER LLC
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Dates
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Enumeration Date | 01/17/2022
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Last Update Date | 07/20/2022
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Provider Practice Location Address
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Address Line | 260 LOOKOUT PL STE 202
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City | MAITLAND
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State | FL
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Zip | 32751-4485
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Country | US
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Telephone | 689-208-0092
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Fax |
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Provider Business Mailing Address
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Address Line | 2017 E 9TH ST UNIT 1706F
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City | CLEVELAND
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State | OH
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Zip | 44115-1335
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Country | US
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Telephone | 813-928-8037
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. TODD MAUTNER
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Credential | DO
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Telephone | 689-208-0092
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number |
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License Number State |
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