Provider Demographics
NPI:1306655840
Name:SUNSHINE FAMILY MEDICAL CENTER, LLC
Entity type:Organization
Organization Name:SUNSHINE FAMILY MEDICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KERVIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DORVAL
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:954-607-5540
Mailing Address - Street 1:3333 W COMMERCIAL BLVD STE 115B
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-3441
Mailing Address - Country:US
Mailing Address - Phone:954-607-5540
Mailing Address - Fax:754-263-5518
Practice Address - Street 1:3333 W COMMERCIAL BLVD STE 115B
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-3441
Practice Address - Country:US
Practice Address - Phone:954-510-3638
Practice Address - Fax:754-263-5518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-30
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty