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General NPI Number Information
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NPI Number | 1710783816
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Entity Type | Individual
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Provider Name | SHIMA SUSAN SUNNY PNP
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Gender | Female
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Dates
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Enumeration Date | 02/20/2025
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Last Update Date | 02/20/2025
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Provider Practice Location Address
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Address Line | 1111 MARCUS AVE
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City | NEW HYDE PARK
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State | NY
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Zip | 11042-1221
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Country | US
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Telephone | 516-601-7200
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Fax |
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Provider Business Mailing Address
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Address Line | 154 WILTON ST
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City | NEW HYDE PARK
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State | NY
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Zip | 11040-3832
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Country | US
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Telephone | 917-691-2563
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 383758
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 163WP0200X
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Taxonomy Name | Pediatric Registered Nurse
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License Number | 710615
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License Number State | NY
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