Provider Demographics
NPI:1720252448
Name:SUNSHINE THERAPEUTIC SERVICES
Entity Type:Organization
Organization Name:SUNSHINE THERAPEUTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:R
Authorized Official - Last Name:IGDALSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC/SLP
Authorized Official - Phone:570-656-2062
Mailing Address - Street 1:PO BOX 41
Mailing Address - Street 2:1510 AL UNSER ROAD
Mailing Address - City:LONG POND
Mailing Address - State:PA
Mailing Address - Zip Code:18334-0041
Mailing Address - Country:US
Mailing Address - Phone:570-656-2062
Mailing Address - Fax:570-643-2867
Practice Address - Street 1:1510 AL UNSER ROAD
Practice Address - Street 2:
Practice Address - City:LONG POND
Practice Address - State:PA
Practice Address - Zip Code:18334-0041
Practice Address - Country:US
Practice Address - Phone:570-656-2062
Practice Address - Fax:570-643-2867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101508344Medicaid