Provider Demographics
NPI:1942584172
Name:SUNNY ISLES MEDICAL CLINIC
Entity Type:Organization
Organization Name:SUNNY ISLES MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ZHANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZITSBANK
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:305-974-0430
Mailing Address - Street 1:17395 N BAY RD
Mailing Address - Street 2:STE 200
Mailing Address - City:SUNNY ISLES BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-3334
Mailing Address - Country:US
Mailing Address - Phone:305-974-0430
Mailing Address - Fax:
Practice Address - Street 1:17395 N BAY RD
Practice Address - Street 2:STE 200
Practice Address - City:SUNNY ISLES BEACH
Practice Address - State:FL
Practice Address - Zip Code:33160-3334
Practice Address - Country:US
Practice Address - Phone:305-974-0430
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-06
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty