MEDICARE: SHU JUAN SUN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MA97621	FL

General Provider Information

NPI Number	:	1407655590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHU JUAN SUN

Provider Business Mailing Address
First Line	:	257A COMMERCIAL BLVD
Second Line	:
City	:	LAUDERDALE BY THE SEA
State	:	FL
Zip	:	33308-4442
Country	:	US
Telephone Number	:	754-332-2851
Fax Number	:

Provider Business Practice Location Address
First Line	:	257A COMMERCIAL BLVD
Second Line	:
City	:	LAUDERDALE BY THE SEA
State	:	FL
Zip	:	33308-4442
Country	:	US
Telephone Number	:	754-332-2851
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/11/2025
Last Update Date	:	03/11/2025

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Directions to “ SHU JUAN SUN ” Practice Location

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