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General NPI Number Information
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NPI Number | 1760668081
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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 | 01/16/2008
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Last Update Date | 11/03/2016
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Provider Practice Location Address
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Address Line | 344 UNIVERSITY BLVD W SUITE 112
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City | SILVER SPRING
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State | MD
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Zip | 20901-1948
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Country | US
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Telephone | 301-593-5440
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Fax |
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Provider Business Mailing Address
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Address Line | 344 UNIVERSITY BLVD W SUITE 112
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City | SILVER SPRING
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State | MD
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Zip | 20901-1948
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Country | US
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Telephone | 301-593-5440
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MAIYA CLARK
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Credential | M.D.
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Telephone | 410-570-3372
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | D0061964
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License Number State | MD
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