Healthcare Provider Details

I. General information

NPI: 1629611272
Provider Name (Legal Business Name): JASMIN SUNNY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2019
Last Update Date: 09/11/2023
Certification Date: 09/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 MOUNT PLEASANT LN
BELLEVILLE IL
62223-3944
US

IV. Provider business mailing address

4005 TAWAKONI LN
GARLAND TX
75043-1848
US

V. Phone/Fax

Practice location:
  • Phone: 618-489-5102
  • Fax:
Mailing address:
  • Phone: 469-734-1562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-67789
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number18-49721
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: