Provider Demographics
NPI:1861294043
Name:SUNSHINE OF MIAMI LAKES CORP
Entity type:Organization
Organization Name:SUNSHINE OF MIAMI LAKES CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:N
Authorized Official - Last Name:LY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-846-3689
Mailing Address - Street 1:7850 NW 146TH ST STE 503
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1516
Mailing Address - Country:US
Mailing Address - Phone:305-846-3689
Mailing Address - Fax:
Practice Address - Street 1:7850 NW 146TH ST STE 503
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-1516
Practice Address - Country:US
Practice Address - Phone:954-446-5440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-26
Last Update Date:2025-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center