Provider Demographics
NPI:1316367808
Name:SUNSHINE PEDIATRIC, P.C.
Entity Type:Organization
Organization Name:SUNSHINE PEDIATRIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ILYA
Authorized Official - Middle Name:
Authorized Official - Last Name:VAYNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-336-1111
Mailing Address - Street 1:1761 E 12TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1013
Mailing Address - Country:US
Mailing Address - Phone:718-336-1111
Mailing Address - Fax:718-336-7576
Practice Address - Street 1:1761 E 12TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1013
Practice Address - Country:US
Practice Address - Phone:718-336-1111
Practice Address - Fax:718-336-7576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-23
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty