MEDICARE: SUN WELLNESS, PLLC

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	207RP1001X	Pulmonary Disease Physician	6226	AZ
2	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	6226	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P21587848	OTHER	AZ	PLLC REGISTRATION

General Provider Information

NPI Number	:	1982143756
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUN WELLNESS, PLLC

Provider Business Mailing Address
First Line	:	6449 E GAINSBOROUGH RD
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85251-1950
Country	:	US
Telephone Number	:	480-812-5828
Fax Number	:	602-840-1290

Provider Business Practice Location Address
First Line	:	10192 W COGGINS DR
Second Line	:
City	:	SUN CITY
State	:	AZ
Zip	:	85351-3405
Country	:	US
Telephone Number	:	480-812-5828
Fax Number	:	602-840-1290

Authorized Official
Title or Position	:	OWNER/MEMBER MANAGER
Name	:	NINA M SHAH
Credential	:	D.O.
Telephone Number	:	480-812-5828

Provider Enumeration Date	:	02/14/2017
Last Update Date	:	03/16/2017

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Directions to “SUN WELLNESS, PLLC ” Practice Location

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