Healthcare Provider Details

I. General information

NPI: 1376335869
Provider Name (Legal Business Name): DARIEN SUN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2025
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CRYSTAL LAKE RD
GROTON CT
06349-2300
US

IV. Provider business mailing address

26 NOB HILL RD APT D
NEW LONDON CT
06320-3238
US

V. Phone/Fax

Practice location:
  • Phone: 954-589-6935
  • Fax:
Mailing address:
  • Phone: 954-589-6935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: