Provider Demographics
NPI:1174968291
Name:SUNNY MEDICAL PC
Entity type:Organization
Organization Name:SUNNY MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:ANASTASIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:NIKISHKINA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-677-7484
Mailing Address - Street 1:1278 OCEAN PARKWAY, GROUND FL
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230
Mailing Address - Country:US
Mailing Address - Phone:718-677-7484
Mailing Address - Fax:718-677-6499
Practice Address - Street 1:1278 OCEAN PARKWAY, GROUND FL
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230
Practice Address - Country:US
Practice Address - Phone:718-677-7484
Practice Address - Fax:718-677-6499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-02
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03474893Medicaid