Provider Demographics
NPI:1104221985
Name:SUNU, EVANS (LPN)
Entity Type:Individual
Prefix:MR
First Name:EVANS
Middle Name:
Last Name:SUNU
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 FREEMAN ST
Mailing Address - Street 2:APT. 1A
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10459-1427
Mailing Address - Country:US
Mailing Address - Phone:347-879-1820
Mailing Address - Fax:
Practice Address - Street 1:801 FREEMAN ST
Practice Address - Street 2:APT. 1A
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10459-1427
Practice Address - Country:US
Practice Address - Phone:347-879-1820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-23
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY316297-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse