Provider Demographics
NPI:1760842280
Name:SIA, SUNNY (ARNP)
Entity Type:Individual
Prefix:
First Name:SUNNY
Middle Name:
Last Name:SIA
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 W MORGAN ST
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33510-4429
Mailing Address - Country:US
Mailing Address - Phone:813-398-0470
Mailing Address - Fax:
Practice Address - Street 1:205 W MORGAN ST
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33510
Practice Address - Country:US
Practice Address - Phone:181-339-8047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-25
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9315395363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01690212OtherRR MEDICARE
FLP01690212OtherRR MEDICARE
FLIM664Y FMC PASCOMedicare PIN
FLIM664ZMedicare PIN