Provider Demographics
NPI:1811595226
Name:SUNSHINE PEDIATRICS, LLC
Entity Type:Organization
Organization Name:SUNSHINE PEDIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:R
Authorized Official - Last Name:ANGLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-750-6621
Mailing Address - Street 1:197 E UNIVERSITY DR STE 2
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36832-6725
Mailing Address - Country:US
Mailing Address - Phone:334-329-7862
Mailing Address - Fax:334-329-7879
Practice Address - Street 1:197 E UNIVERSITY DR STE 2
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36832-6725
Practice Address - Country:US
Practice Address - Phone:334-329-7862
Practice Address - Fax:334-329-7879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-16
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL267459Medicaid