Provider Demographics
NPI:1992018873
Name:SUNSHINE PEDIATRICS OF NC PLLC
Entity Type:Organization
Organization Name:SUNSHINE PEDIATRICS OF NC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER/PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:OGIEMWONYI
Authorized Official - Middle Name:ELEKHUOBA
Authorized Official - Last Name:ASEMOTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-484-4233
Mailing Address - Street 1:509 SANDHURST DRIVE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-4433
Mailing Address - Country:US
Mailing Address - Phone:910-484-4233
Mailing Address - Fax:910-484-2990
Practice Address - Street 1:514 OWEN DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3432
Practice Address - Country:US
Practice Address - Phone:910-423-4233
Practice Address - Fax:910-423-0513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-20
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9700454208000000X
NC208000000X
NC97-00454208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5918692Medicaid
NC5918692Medicaid