=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275921371
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUNNY ENLIGHTENING CORP.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/26/2014
-----------------------------------------------------
Last Update Date | 12/26/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 289 BIDWELL AVE
-----------------------------------------------------
City | STATEN ISLAND
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10314-3150
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-619-5013
-----------------------------------------------------
Fax | 718-816-1995
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 289 BIDWELL AVE
-----------------------------------------------------
City | STATEN ISLAND
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10314-3150
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-619-5013
-----------------------------------------------------
Fax | 718-816-1995
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SPECIAL EDUCATION TEACHER
-----------------------------------------------------
Name | CICILY MANNIL SUNNY
-----------------------------------------------------
Credential | MS ED
-----------------------------------------------------
Telephone | 718-619-5013
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 252Y00000X
-----------------------------------------------------
Taxonomy Name | Early Intervention Provider Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------