=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972448553
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SECONDSUN TECHNOLOGIES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/21/2026
-----------------------------------------------------
Last Update Date | 04/21/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1135 HEAVENLY DR
-----------------------------------------------------
City | SAINT CLOUD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34769-5347
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 657-554-3386
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1135 HEAVENLY DR
-----------------------------------------------------
City | SAINT CLOUD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34769-5347
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 657-554-3386
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF OPERATIONS
-----------------------------------------------------
Name | WESLEY CAMERON
-----------------------------------------------------
Credential | DOO
-----------------------------------------------------
Telephone | 657-554-3386
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 246YR1600X
-----------------------------------------------------
Taxonomy Name | Registered Record Administrator
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------