MEDICARE: SUNSTATE SENIOR CARE 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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1417802596
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNSTATE SENIOR CARE LLC

Provider Business Mailing Address
First Line	:	16442 TURNBURY OAK DR
Second Line	:
City	:	ODESSA
State	:	FL
Zip	:	33556-2896
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	16442 TURNBURY OAK DR
Second Line	:
City	:	ODESSA
State	:	FL
Zip	:	33556-2896
Country	:	US
Telephone Number	:	727-466-3000
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	VINCENT MATTHEW BRYNICZKA
Credential	:
Telephone Number	:	630-730-2737

Provider Enumeration Date	:	03/03/2026
Last Update Date	:	03/03/2026

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