Healthcare Provider Details

I. General information

NPI: 1972081800
Provider Name (Legal Business Name): SUNSHINE PROSTHETICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2018
Last Update Date: 10/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 NASH ST SW STE E
WILSON NC
27893-3917
US

IV. Provider business mailing address

2302 NASH ST N STE E-400
WILSON NC
27896-1741
US

V. Phone/Fax

Practice location:
  • Phone: 252-881-0118
  • Fax:
Mailing address:
  • Phone: 252-881-0118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: JOHN CLARKE
Title or Position: OWNER
Credential:
Phone: 252-881-0118