Provider Demographics
NPI:1437697265
Name:SUN NEURO PA
Entity type:Organization
Organization Name:SUN NEURO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRPERSON
Authorized Official - Prefix:
Authorized Official - First Name:ADAEZE
Authorized Official - Middle Name:
Authorized Official - Last Name:ONUOHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-675-5597
Mailing Address - Street 1:10657 VISTA DEL SOL DR STE F
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79935-4504
Mailing Address - Country:US
Mailing Address - Phone:915-303-7548
Mailing Address - Fax:915-303-7558
Practice Address - Street 1:10657 VISTA DEL SOL DR STE F
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79935-4504
Practice Address - Country:US
Practice Address - Phone:915-303-7548
Practice Address - Fax:915-303-7558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-31
Last Update Date:2020-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ445712084A2900X
MO20090070632084A2900X
TXQ17002084A2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084A2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurocritical CareGroup - Single Specialty