Healthcare Provider Details

I. General information

NPI: 1740622166
Provider Name (Legal Business Name): SUNSHINE PEDIATRIC AND ADOLESCENT CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2013
Last Update Date: 07/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1631 MIDTOWN PL STE 107
RALEIGH NC
27609-1300
US

IV. Provider business mailing address

1631 MIDTOWN PL STE 107
RALEIGH NC
27609-1300
US

V. Phone/Fax

Practice location:
  • Phone: 919-876-5656
  • Fax: 919-876-1515
Mailing address:
  • Phone: 919-876-5656
  • Fax: 919-876-1515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number4451727
License Number StateNC

VIII. Authorized Official

Name: DR. ALBERTINA DENISE SMITH-BANKS
Title or Position: OWNER
Credential: M.D.
Phone: 919-876-5656