Healthcare Provider Details

I. General information

NPI: 1083325781
Provider Name (Legal Business Name): SUNSHINE JONES BALLENTINE CERTIFIED HAIR LOSS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2022
Last Update Date: 03/14/2024
Certification Date: 03/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 N YORK ST
ELMHURST IL
60126-1604
US

IV. Provider business mailing address

915 N YORK ST APT 603
ELMHURST IL
60126-1256
US

V. Phone/Fax

Practice location:
  • Phone: 312-520-8824
  • Fax: 630-501-0012
Mailing address:
  • Phone: 312-520-8824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: