Healthcare Provider Details

I. General information

NPI: 1326113481
Provider Name (Legal Business Name): SUNNY N THOMPSON NELSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUNNY NOEL THOMPSON MD

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 09/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3460 SOUTH ST
MORRISVILLE NY
13408-9671
US

IV. Provider business mailing address

150 BROAD ST
HAMILTON NY
13346-9575
US

V. Phone/Fax

Practice location:
  • Phone: 315-684-3117
  • Fax:
Mailing address:
  • Phone: 315-684-3117
  • Fax: 315-684-9848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD27044
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: