MEDICARE: NI SUN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	709254-1	NY
2	363LF0000X	Family Nurse Practitioner	F350877	NY

General Provider Information

NPI Number	:	1487153417
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NI SUN

Provider Business Mailing Address
First Line	:	3907 PRINCE ST
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11354-5357
Country	:	US
Telephone Number	:	718-888-9123
Fax Number	:

Provider Business Practice Location Address
First Line	:	3907 PRINCE ST STE 2D
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11354-5321
Country	:	US
Telephone Number	:	718-888-9123
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2018
Last Update Date	:	03/15/2023

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Directions to “ NI SUN ” Practice Location

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