Provider Demographics
NPI:1376723916
Name:SUNNY INTERNAL MEDICINE AND PEDIATRICS, PLLC
Entity Type:Organization
Organization Name:SUNNY INTERNAL MEDICINE AND PEDIATRICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:MAITRA
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:623-882-0077
Mailing Address - Street 1:3400 N DYSART RD
Mailing Address - Street 2:SUITE G-127
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-1003
Mailing Address - Country:US
Mailing Address - Phone:623-882-0077
Mailing Address - Fax:623-882-9977
Practice Address - Street 1:3400 N DYSART RD STE G127
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-1003
Practice Address - Country:US
Practice Address - Phone:623-882-0077
Practice Address - Fax:623-882-9977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-12
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31741207R00000X, 208000000X
AZ31810207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ77754Medicare PIN