Provider Demographics
NPI:1154442929
Name:SUNSHINE MEDICAL SERVICES
Entity Type:Organization
Organization Name:SUNSHINE MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:JEANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MANNING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-271-0880
Mailing Address - Street 1:2255 LYELL AVE
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14606-5744
Mailing Address - Country:US
Mailing Address - Phone:585-271-0880
Mailing Address - Fax:
Practice Address - Street 1:2255 LYELL AVE
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14606-5744
Practice Address - Country:US
Practice Address - Phone:585-271-0880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00805587Medicaid
NY00805587Medicaid