MEDICARE: SUNSHINE DOCTORS GROUP. 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	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1497198816
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNSHINE DOCTORS GROUP. LLC

Provider Business Mailing Address
First Line	:	PO BOX 733154
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75373-3154
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3531 SW CORPORATE PARKWAY
Second Line	:	ROOM 1
City	:	PALM CITY
State	:	FL
Zip	:	34990
Country	:	US
Telephone Number	:	772-872-6025
Fax Number	:	772-872-6128

Authorized Official
Title or Position	:	CHIEF ADMINISTRATIVE OFFICER
Name	:	MR. EDWARD ROUSSEAU
Credential	:
Telephone Number	:	772-266-7682

Provider Enumeration Date	:	04/16/2013
Last Update Date	:	08/09/2018

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