MEDICARE: SUNSHINE HOME PHYSICIANS, 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	207R00000X	Internal Medicine Physician	ME0071110	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2016545903	OTHER		TAX IDENTIFICATION

General Provider Information

NPI Number	:	1346395688
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNSHINE HOME PHYSICIANS, LLC

Provider Business Mailing Address
First Line	:	12360 66TH ST
Second Line	:	SUITE V1
City	:	LARGO
State	:	FL
Zip	:	33773-3434
Country	:	US
Telephone Number	:	727-530-4606
Fax Number	:	727-231-0734

Provider Business Practice Location Address
First Line	:	12360 66TH ST
Second Line	:	SUITE V1
City	:	LARGO
State	:	FL
Zip	:	33773-3434
Country	:	US
Telephone Number	:	727-530-4606
Fax Number	:	727-231-0734

Authorized Official
Title or Position	:	OWNER
Name	:	LINDA PRIETO
Credential	:	MD
Telephone Number	:	727-530-4606

Provider Enumeration Date	:	01/25/2007
Last Update Date	:	08/22/2020

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