Provider Demographics
NPI:1316523640
Name:SUNNYSIDE MENTAL HEALTH LLC
Entity type:Organization
Organization Name:SUNNYSIDE MENTAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:YUSELIS
Authorized Official - Middle Name:
Authorized Official - Last Name:TITO AMADOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-497-0977
Mailing Address - Street 1:1490 W 49TH PL STE 309
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-8131
Mailing Address - Country:US
Mailing Address - Phone:305-843-9333
Mailing Address - Fax:786-567-4764
Practice Address - Street 1:1490 W 49TH PL STE 309
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-8131
Practice Address - Country:US
Practice Address - Phone:305-333-3333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-18
Last Update Date:2025-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)