MEDICARE: STARLIGHT MEDICAL SUPPLIES 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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1962092692
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STARLIGHT MEDICAL SUPPLIES LLC

Provider Business Mailing Address
First Line	:	1975 E SUNRISE BLVD STE 525
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33304-1409
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1975 E SUNRISE BLVD STE 525
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33304-1409
Country	:	US
Telephone Number	:	954-801-2257
Fax Number	:

Authorized Official
Title or Position	:	OWNER/AUTHORIZED OFFICIAL
Name	:	ANDRE J MINOTT
Credential	:
Telephone Number	:	954-801-2257

Provider Enumeration Date	:	01/26/2021
Last Update Date	:	01/27/2021

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