Provider Demographics
NPI:1285915603
Name:SUNSHINE PEDIATRICS OF OCALA PA
Entity type:Organization
Organization Name:SUNSHINE PEDIATRICS OF OCALA PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MADHUKAR
Authorized Official - Middle Name:
Authorized Official - Last Name:SHRINATH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-840-5437
Mailing Address - Street 1:1900 SW 20TH PL
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-7870
Mailing Address - Country:US
Mailing Address - Phone:352-840-5437
Mailing Address - Fax:352-237-1094
Practice Address - Street 1:1900 SW 20TH PL
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471
Practice Address - Country:US
Practice Address - Phone:352-840-5437
Practice Address - Fax:352-237-1094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-30
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME76333208000000X
261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL254422900Medicaid
FL254422900Medicaid