Healthcare Provider Details

I. General information

NPI: 1174401269
Provider Name (Legal Business Name): SUNSHINE ADVANTAGE OF TENNESSEE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2025
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8295 TOURNAMENT DR STE 150
MEMPHIS TN
38125-8900
US

IV. Provider business mailing address

2170 LAKEWOOD RD STE 206
TOMS RIVER NJ
08755-1669
US

V. Phone/Fax

Practice location:
  • Phone: 855-973-1235
  • Fax:
Mailing address:
  • Phone: 732-466-9010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: MIRIAM LICHTSCHEIN
Title or Position: MEMBER
Credential:
Phone: 347-971-0039