MEDICARE: SUNNY PATH THERAPY, 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	235Z00000X	Speech-Language Pathologist

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	:	1619451085
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNNY PATH THERAPY, LLC

Provider Business Mailing Address
First Line	:	3278 CANOE CREEK RD
Second Line	:
City	:	SAINT CLOUD
State	:	FL
Zip	:	34772-9115
Country	:	US
Telephone Number	:	321-837-9737
Fax Number	:	321-837-9207

Provider Business Practice Location Address
First Line	:	3278 CANOE CREEK RD
Second Line	:
City	:	SAINT CLOUD
State	:	FL
Zip	:	34772-9115
Country	:	US
Telephone Number	:	321-837-9737
Fax Number	:	321-837-9207

Authorized Official
Title or Position	:	OWNER
Name	:	CAITLIN SMITH
Credential	:
Telephone Number	:	321-837-9737

Provider Enumeration Date	:	09/20/2018
Last Update Date	:	12/03/2024

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Directions to “SUNNY PATH THERAPY, LLC ” Practice Location

Language	Start Address	Practice Location

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