Provider Demographics
NPI:1215405907
Name:MORENO, SUNNI D
Entity Type:Individual
Prefix:MRS
First Name:SUNNI
Middle Name:D
Last Name:MORENO
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SUNNI
Other - Middle Name:D
Other - Last Name:RAULERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1328 FOXBORO DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-6209
Mailing Address - Country:US
Mailing Address - Phone:321-331-9730
Mailing Address - Fax:
Practice Address - Street 1:1328 FOXBORO DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-6209
Practice Address - Country:US
Practice Address - Phone:321-331-9730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-11
Last Update Date:2018-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9375377367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered