Healthcare Provider Details

I. General information

NPI: 1679367403
Provider Name (Legal Business Name): SUNNYSIDE DAY HUB INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2025
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 DELAWARE AVE
BUFFALO NY
14202-1304
US

IV. Provider business mailing address

490 DELAWARE AVE
BUFFALO NY
14202-1304
US

V. Phone/Fax

Practice location:
  • Phone: 585-416-8107
  • Fax:
Mailing address:
  • Phone: 585-416-8107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. OLES TKACH
Title or Position: OWNER
Credential:
Phone: 585-416-8107