Healthcare Provider Details

I. General information

NPI: 1366558025
Provider Name (Legal Business Name): SUNSHINE PEDIATRICS & ADOLESCENT CARE, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1631 MIDTOWN PL SUITE 107
RALEIGH NC
27609-1300
US

IV. Provider business mailing address

PO BOX 30696
GREENVILLE NC
27833-0696
US

V. Phone/Fax

Practice location:
  • Phone: 919-876-1515
  • Fax: 919-876-5656
Mailing address:
  • Phone: 252-353-7162
  • Fax: 252-353-1760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateNC

VIII. Authorized Official

Name: MR. MARCUS W GILLIKIN
Title or Position: CONSULTANT
Credential: MD, MBA
Phone: 252-353-7162