Healthcare Provider Details

I. General information

NPI: 1295444073
Provider Name (Legal Business Name): SUNSHINE ADVANTAGE OF NM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2022
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 WASHINGTON AVE STE 201
SANTA FE NM
87501-2038
US

IV. Provider business mailing address

1439 SOUTH ST
LAKEWOOD NJ
08701-5440
US

V. Phone/Fax

Practice location:
  • Phone: 732-523-2327
  • Fax:
Mailing address:
  • Phone: 732-523-2327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: MIRIAM LICHTSCHEIN
Title or Position: MEMBER
Credential:
Phone: 347-971-0039