Provider Demographics
NPI:1184263675
Name:SUNKISS ESSENTIALS LLC
Entity type:Organization
Organization Name:SUNKISS ESSENTIALS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:DE BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:234-281-2660
Mailing Address - Street 1:2926 STATE RD STE 369
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44223-1244
Mailing Address - Country:US
Mailing Address - Phone:234-281-2660
Mailing Address - Fax:
Practice Address - Street 1:2926 STATE RD STE 369
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44223-1244
Practice Address - Country:US
Practice Address - Phone:234-281-2660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-31
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty