MEDICARE: COASTAL SUNSHINE AND REIGN

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	222Q00000X	Developmental Therapist

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	:	1194451443
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COASTAL SUNSHINE AND REIGN

Provider Business Mailing Address
First Line	:	3487 SHORTLEAF CT
Second Line	:
City	:	CANTONMENT
State	:	FL
Zip	:	32533-8449
Country	:	US
Telephone Number	:	850-284-2093
Fax Number	:

Provider Business Practice Location Address
First Line	:	2441 N 9TH AVE STE B
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32503-3989
Country	:	US
Telephone Number	:	850-284-2093
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MISS EBONI LYONS
Credential	:
Telephone Number	:	850-284-2093

Provider Enumeration Date	:	07/28/2022
Last Update Date	:	08/09/2022

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Directions to “COASTAL SUNSHINE AND REIGN ” Practice Location

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