Healthcare Provider Details

I. General information

NPI: 1235315284
Provider Name (Legal Business Name): SUNSHINE PEDIATRICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2008
Last Update Date: 07/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 RANDALL SQ SUITE 404-406
PROVIDENCE RI
02904-2709
US

IV. Provider business mailing address

1 RANDALL SQ SUITE 404-406
PROVIDENCE RI
02904-2709
US

V. Phone/Fax

Practice location:
  • Phone: 401-861-5183
  • Fax: 401-861-5276
Mailing address:
  • Phone: 401-861-5183
  • Fax: 401-861-5276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number09832
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number10462
License Number StateRI

VIII. Authorized Official

Name: DR. PAUL WAHIB WEHBE
Title or Position: OWNER
Credential: M.D.
Phone: 401-861-5183