Provider Demographics
NPI:1972016384
Name:SUNNYSSIX, PLLC
Entity Type:Organization
Organization Name:SUNNYSSIX, PLLC
Other - Org Name:COMMUNITY FIRST PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NIDISH
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:817-823-5464
Mailing Address - Street 1:2410 LUNA RD # 204
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-6538
Mailing Address - Country:US
Mailing Address - Phone:469-844-7072
Mailing Address - Fax:
Practice Address - Street 1:2410 LUNA RD # 204
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-6538
Practice Address - Country:US
Practice Address - Phone:844-469-7072
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-07
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP134568363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty