Healthcare Provider Details

I. General information

NPI: 1760668081
Provider Name (Legal Business Name): SUNSHINE PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2008
Last Update Date: 11/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

344 UNIVERSITY BLVD W SUITE 112
SILVER SPRING MD
20901-1948
US

IV. Provider business mailing address

344 UNIVERSITY BLVD W SUITE 112
SILVER SPRING MD
20901-1948
US

V. Phone/Fax

Practice location:
  • Phone: 301-593-5440
  • Fax:
Mailing address:
  • Phone: 301-593-5440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberD0061964
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. MAIYA CLARK
Title or Position: OWNER
Credential: M.D.
Phone: 410-570-3372