# SUN MIRACLE WELLNESS CENTER LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164130613
- **Authorized official:** SHANTA K DAVIS AGNP-C (OWNER)
- **Authorized official phone:** (727) 741-8475

## Contact information

- **Practice address:** 13575 58TH ST N STE 200, CLEARWATER, FL 33760-3739
- **Practice address phone:** (727) 741-8475
- **Mailing address:** 6740 CROSSWINDS DR N STE C, ST PETERSBURG, FL 33710-5472
- **Mailing address phone:** (727) 954-0010

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QP2300X | Primary Care Clinic/Center | — | NULL | — |
| 363LA2200X | Adult Health Nurse Practitioner | — | NULL | Yes |
| 363LA2200X | Adult Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 11/14/2022
- **Last updated:** 09/25/2023