MEDICARE: SUNNY TANECKA LAC

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	171100000X	Acupuncturist	2264	CO
2	171100000X	Acupuncturist	0121-001020	VA

General Provider Information

NPI Number	:	1891221966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUNNY TANECKA LAC

Provider Business Mailing Address
First Line	:	2201 MOUNT VERNON AVE
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22301-1313
Country	:	US
Telephone Number	:	571-305-3136
Fax Number	:	571-989-6233

Provider Business Practice Location Address
First Line	:	2202 MOUNT VERNON AVE
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22301-1396
Country	:	US
Telephone Number	:	571-305-3136
Fax Number	:	571-989-6233

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

Provider Enumeration Date	:	05/10/2017
Last Update Date	:	10/09/2025

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Directions to “ SUNNY TANECKA LAC” Practice Location

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