Provider Demographics
NPI:1083378996
Name:SUN, RAVY S (RN)
Entity Type:Individual
Prefix:
First Name:RAVY
Middle Name:S
Last Name:SUN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:5801 HEATHERWOOD LOOP
Mailing Address - Street 2:
Mailing Address - City:SACHSE
Mailing Address - State:TX
Mailing Address - Zip Code:75048-4193
Mailing Address - Country:US
Mailing Address - Phone:617-669-5550
Mailing Address - Fax:
Practice Address - Street 1:3413 SPECTRUM BLVD
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-9705
Practice Address - Country:US
Practice Address - Phone:972-884-4160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-26
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MARN2311466163WM0705X
TX1111476363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical