=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568163574
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MAY SUN HOME HEALTH NURSES, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/15/2023
-----------------------------------------------------
Last Update Date | 03/15/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2689 NINFIELD DR
-----------------------------------------------------
City | WINSTON SALEM
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27103-6989
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-857-0248
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5540 CENTERVIEW DR STE 204 PMB 787260
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27606-8012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-857-0248
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | ESTELLA G CHISHOLM
-----------------------------------------------------
Credential | RN BSN MHA
-----------------------------------------------------
Telephone | 619-857-0248
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------