Healthcare Provider Details

I. General information

NPI: 1558080531
Provider Name (Legal Business Name): SUNSTAR PSYCHIATRIC NP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2022
Last Update Date: 08/24/2022
Certification Date: 08/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

381 BARLOW AVE
STATEN ISLAND NY
10308-1301
US

IV. Provider business mailing address

381 BARLOW AVE
STATEN ISLAND NY
10308-1301
US

V. Phone/Fax

Practice location:
  • Phone: 347-570-7007
  • Fax:
Mailing address:
  • Phone: 347-570-7007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: YUAN ZHANG
Title or Position: OWNER
Credential: NURSE PRACTITIONER
Phone: 347-570-7007