Healthcare Provider Details

I. General information

NPI: 1871364612
Provider Name (Legal Business Name): SUNNY SHOT L.L.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2024
Last Update Date: 01/10/2024
Certification Date: 01/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9037 52ND AVE APT 3F
ELMHURST NY
11373-4026
US

IV. Provider business mailing address

9037 52ND AVE APT 3F
ELMHURST NY
11373-4026
US

V. Phone/Fax

Practice location:
  • Phone: 929-571-4716
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: DMITRII SOSHNIKOV
Title or Position: AMBR
Credential:
Phone: 929-571-4716