MEDICARE: SUNNY JAIN

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	31891	SC

General Provider Information

NPI Number	:	1730016452
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUNNY JAIN

Provider Business Mailing Address
First Line	:	1171 MARKET ST STE 201
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29708-6514
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1171 MARKET ST STE 201
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29708-6514
Country	:	US
Telephone Number	:	419-297-3657
Fax Number	:

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

Provider Enumeration Date	:	05/06/2026
Last Update Date	:	05/16/2026

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Directions to “ SUNNY JAIN ” Practice Location

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