Healthcare Provider Details

I. General information

NPI: 1629169693
Provider Name (Legal Business Name): SUNSHINE PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

724 ARDEN LN SUITE 100
ROCK HILL SC
29732-2996
US

IV. Provider business mailing address

724 ARDEN LN SUITE 100
ROCK HILL SC
29732-2996
US

V. Phone/Fax

Practice location:
  • Phone: 803-980-7337
  • Fax: 803-980-2229
Mailing address:
  • Phone: 803-980-7337
  • Fax: 803-980-2229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHAILA PATEL
Title or Position: ADMINISTRATOR
Credential:
Phone: 803-980-7337