MEDICARE: SUNROOM PSYCHIATRY PLLC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1669216867
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNROOM PSYCHIATRY PLLC

Provider Business Mailing Address
First Line	:	23W232 FOXCROFT DR
Second Line	:
City	:	GLEN ELLYN
State	:	IL
Zip	:	60137-6533
Country	:	US
Telephone Number	:	847-922-5750
Fax Number	:

Provider Business Practice Location Address
First Line	:	3429 W FULLERTON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-2415
Country	:	US
Telephone Number	:	708-824-7807
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TESSA SCHULTZ
Credential	:	DNP, APRN, PMHNP
Telephone Number	:	847-922-5750

Provider Enumeration Date	:	06/21/2024
Last Update Date	:	06/21/2024

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