Provider Demographics
NPI:1619618964
Name:SUNSHINE PEDIATRIC AND FAMILY CLINIC LLC
Entity Type:Organization
Organization Name:SUNSHINE PEDIATRIC AND FAMILY CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SRINIVASA
Authorized Official - Middle Name:REDDY
Authorized Official - Last Name:YERASI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-332-3971
Mailing Address - Street 1:555 LAKES BLVD
Mailing Address - Street 2:
Mailing Address - City:BREAUX BRIDGE
Mailing Address - State:LA
Mailing Address - Zip Code:70517-3240
Mailing Address - Country:US
Mailing Address - Phone:337-332-3971
Mailing Address - Fax:337-735-3046
Practice Address - Street 1:555 LAKES BLVD
Practice Address - Street 2:
Practice Address - City:BREAUX BRIDGE
Practice Address - State:LA
Practice Address - Zip Code:70517-3240
Practice Address - Country:US
Practice Address - Phone:337-332-3971
Practice Address - Fax:337-735-3046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-01
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty