Provider Demographics
NPI:1558469155
Name:DELAHUNTY, SUNNI LEIGH (PA-C)
Entity Type:Individual
Prefix:MS
First Name:SUNNI
Middle Name:LEIGH
Last Name:DELAHUNTY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SUNNI
Other - Middle Name:LEIGH
Other - Last Name:BARNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2300 N EDWARD ST
Mailing Address - Street 2:GSBLL
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-4163
Mailing Address - Country:US
Mailing Address - Phone:217-876-2857
Mailing Address - Fax:217-876-2874
Practice Address - Street 1:241 W WEAVER RD
Practice Address - Street 2:SUITE 145C
Practice Address - City:FORSYTH
Practice Address - State:IL
Practice Address - Zip Code:62535
Practice Address - Country:US
Practice Address - Phone:217-876-5200
Practice Address - Fax:217-876-5206
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085002320363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q27876Medicare UPIN
K33095Medicare PIN