Healthcare Provider Details

I. General information

NPI: 1598074254
Provider Name (Legal Business Name): SUNSHINE PEDIATRICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2010
Last Update Date: 09/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14402 JEWEL AVE
FLUSHING NY
11367-1744
US

IV. Provider business mailing address

PO BOX 670008
FLUSHING NY
11367-0008
US

V. Phone/Fax

Practice location:
  • Phone: 718-880-2050
  • Fax: 718-880-2052
Mailing address:
  • Phone: 718-880-2050
  • Fax: 718-880-2052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number151792
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. ADA HASS
Title or Position: OWNER
Credential: M.D.
Phone: 718-880-2050