Provider Demographics
NPI:1023448388
Name:SUNSHINY MENTAL HEALTH PLLC
Entity type:Organization
Organization Name:SUNSHINY MENTAL HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KHAJA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHISTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-987-8117
Mailing Address - Street 1:PO BOX 451959
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33345-1959
Mailing Address - Country:US
Mailing Address - Phone:720-515-9112
Mailing Address - Fax:888-958-5968
Practice Address - Street 1:19330 SW 69TH ST
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33332-1652
Practice Address - Country:US
Practice Address - Phone:754-666-1911
Practice Address - Fax:888-958-5968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-22
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1097052084B0040X
COPA.0003414363A00000X
CODR.00512652084P0800X, 2084P0800X, 2084P0800X
COLPC.005173103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Yes2084B0040XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBehavioral Neurology & NeuropsychiatryGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO130080684OtherDRIVERS LICENSE