Provider Demographics
NPI:1619154663
Name:SUN, NUBIAN
Entity Type:Individual
Prefix:DR
First Name:NUBIAN
Middle Name:
Last Name:SUN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 BRENTWOOD OAKS DRIVE
Mailing Address - Street 2:ATTN: DR. NUBIAN SUN
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211
Mailing Address - Country:US
Mailing Address - Phone:901-279-6775
Mailing Address - Fax:
Practice Address - Street 1:204 BRENTWOOD OAKS DRIVE
Practice Address - Street 2:ATTN: DR. NUBIAN SUN
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211
Practice Address - Country:US
Practice Address - Phone:901-279-6775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-22
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN55981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN$$$$$$$$$Medicaid