Healthcare Provider Details

I. General information

NPI: 1881908358
Provider Name (Legal Business Name): SUNSHINE PEDIATRICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2010
Last Update Date: 01/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

487 W MAIN ST
WEST JEFFERSON OH
43162-1178
US

IV. Provider business mailing address

487 W MAIN ST
WEST JEFFERSON OH
43162-1178
US

V. Phone/Fax

Practice location:
  • Phone: 419-529-7236
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number34009435
License Number StateOH

VIII. Authorized Official

Name: DR. DANA E. LENHART
Title or Position: PHYSICIAN
Credential: D.O.
Phone: 419-529-7236