Healthcare Provider Details

I. General information

NPI: 1457285934
Provider Name (Legal Business Name): SUNNY L FULTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2138 PRIEST BRIDGE CT STE 1
CROFTON MD
21114-2463
US

IV. Provider business mailing address

14806 FIRST BAPTIST LN
LAUREL MD
20707-6927
US

V. Phone/Fax

Practice location:
  • Phone: 667-239-8348
  • Fax:
Mailing address:
  • Phone: 443-552-0507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number34743
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: