Healthcare Provider Details

I. General information

NPI: 1396612099
Provider Name (Legal Business Name): ERIN SUN PA-C
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2025
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 KINGSBOROUGH SQ STE 100
CHESAPEAKE VA
23320-5041
US

IV. Provider business mailing address

612 KINGSBOROUGH SQ STE 100
CHESAPEAKE VA
23320-5041
US

V. Phone/Fax

Practice location:
  • Phone: 757-547-9294
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110012047
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0110012047
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: