Healthcare Provider Details

I. General information

NPI: 1710783816
Provider Name (Legal Business Name): SHIMA SUSAN SUNNY PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2025
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 MARCUS AVE
NEW HYDE PARK NY
11042-1221
US

IV. Provider business mailing address

154 WILTON ST
NEW HYDE PARK NY
11040-3832
US

V. Phone/Fax

Practice location:
  • Phone: 516-601-7200
  • Fax:
Mailing address:
  • Phone: 917-691-2563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number383758
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number710615
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: