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General NPI Number Information
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NPI Number | 1144508698
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Entity Type | Organization
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Legal Business Name | SUNSHINE PEDIATRICS
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Dates
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Enumeration Date | 08/02/2011
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Last Update Date | 06/25/2020
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Provider Practice Location Address
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Address Line | 514 OWEN DRIVE
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City | FAYETTEVILLE
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State | NC
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Zip | 28304
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Country | US
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Telephone | 910-484-4233
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Fax |
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Provider Business Mailing Address
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Address Line | 514 OWEN DRIVE
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City | FAYETTEVILLE
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State | NC
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Zip | 28304
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Country | US
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Telephone | 910-484-4233
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Fax |
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Authorized Official
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Title or Position | PRACTICE OWNER/PROVIDER
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Name | OGIEMWONYI ELEKHUOBA ASEMOTA
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Credential | M.D.
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Telephone | 910-484-4233
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 97-00454
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License Number State | NC
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