Healthcare Provider Details

I. General information

NPI: 1700234622
Provider Name (Legal Business Name): SUNNY HONG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2016
Last Update Date: 06/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

269 MEDICAL PARK BLVD
PETERSBURG VA
23805-9337
US

IV. Provider business mailing address

269 MEDICAL PARK BLVD
PETERSBURG VA
23805-9337
US

V. Phone/Fax

Practice location:
  • Phone: 804-861-0700
  • Fax: 804-863-4626
Mailing address:
  • Phone: 804-861-0700
  • Fax: 804-863-4626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810004087
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: