MEDICARE: SUNSHINE SENSORY SPECTRUMS 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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093468563
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNSHINE SENSORY SPECTRUMS LLC

Provider Business Mailing Address
First Line	:	6631 FORT KING RD APT 407
Second Line	:
City	:	ZEPHYRHILLS
State	:	FL
Zip	:	33542-4843
Country	:	US
Telephone Number	:	201-838-9372
Fax Number	:

Provider Business Practice Location Address
First Line	:	6631 FORT KING RD APT 407
Second Line	:
City	:	ZEPHYRHILLS
State	:	FL
Zip	:	33542-4843
Country	:	US
Telephone Number	:	201-838-9372
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MS. JENNEAL M LYONS
Credential	:
Telephone Number	:	201-838-9372

Provider Enumeration Date	:	02/03/2022
Last Update Date	:	02/03/2022

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