=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801289947
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUNCARE PSYCHIATRIC SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/13/2015
-----------------------------------------------------
Last Update Date | 07/13/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1662 MCKAY CT
-----------------------------------------------------
City | DUNEDIN
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34698-3529
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-744-8686
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1662 MCKAY CT
-----------------------------------------------------
City | DUNEDIN
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34698-3529
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-744-8686
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ARNP
-----------------------------------------------------
Name | MRS. CHERYL MCLEAN
-----------------------------------------------------
Credential | ARNP
-----------------------------------------------------
Telephone | 727-744-8686
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 3383532
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------