Healthcare Provider Details

I. General information

NPI: 1336607746
Provider Name (Legal Business Name): SUNLIGHT MEDICAL SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2019
Last Update Date: 06/17/2021
Certification Date: 06/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5750 W THUNDERBIRD RD SUITE F-640
GLENDALE AZ
85306
US

IV. Provider business mailing address

5750 W THUNDERBIRD RD SUITE F-640
GLENDALE AZ
85306
US

V. Phone/Fax

Practice location:
  • Phone: 480-300-6065
  • Fax: 855-923-0899
Mailing address:
  • Phone: 480-300-6065
  • Fax: 855-923-0899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: VICKY DRAMARETSKA
Title or Position: OWNER/PROVIDER
Credential: PA-C
Phone: 480-300-6065