MEDICARE: SUNSHINE PREMIER WELLNESS CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1063986461
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNSHINE PREMIER WELLNESS CENTER LLC

Provider Business Mailing Address
First Line	:	4365 HUNTERS PARK LN # 50
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32837-7614
Country	:	US
Telephone Number	:	407-412-5160
Fax Number	:	833-212-3716

Provider Business Practice Location Address
First Line	:	4365 HUNTERS PARK LN # 50
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32837-7614
Country	:	US
Telephone Number	:	407-412-5160
Fax Number	:	833-212-3716

Authorized Official
Title or Position	:	OWNER
Name	:	DR. INDHIRA ALMONTE
Credential	:	MD
Telephone Number	:	813-715-9802

Provider Enumeration Date	:	01/18/2019
Last Update Date	:	01/18/2019

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