Healthcare Provider Details

I. General information

NPI: 1033704630
Provider Name (Legal Business Name): SUNLYTE TREATMENT CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2021
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2556 N FRONT ST
PHILADELPHIA PA
19133-4004
US

IV. Provider business mailing address

2556 N FRONT ST
PHILADELPHIA PA
19133-4004
US

V. Phone/Fax

Practice location:
  • Phone: 215-205-2294
  • Fax:
Mailing address:
  • Phone: 267-457-3801
  • Fax: 267-457-3832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JANELL L. CLARK
Title or Position: OWNER
Credential: APN-BC
Phone: 215-205-2294