MEDICARE: SUNSHINE PHYSICIAN ASSOCIATES 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	ME 92513	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ME 92513	OTHER	FL	FLORIDA MEDICAL LICENSE

General Provider Information

NPI Number	:	1760627566
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNSHINE PHYSICIAN ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	4755 SUMMERLIN RD
Second Line	:	STE 8
City	:	FORT MYERS
State	:	FL
Zip	:	33919-1073
Country	:	US
Telephone Number	:	239-565-3010
Fax Number	:	239-275-5592

Provider Business Practice Location Address
First Line	:	4755 SUMMERLIN RD
Second Line	:	# 8
City	:	FORT MYERS
State	:	FL
Zip	:	33919-1073
Country	:	US
Telephone Number	:	239-275-5339
Fax Number	:	239-275-5592

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MIGDALIA VALENTIN
Credential	:	M.D.,
Telephone Number	:	239-275-5339

Provider Enumeration Date	:	12/08/2008
Last Update Date	:	02/25/2013

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