Provider Demographics
NPI:1043385115
Name:SUNSHINE PRIMARY CARE PA
Entity type:Organization
Organization Name:SUNSHINE PRIMARY CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SABARI
Authorized Official - Middle Name:LAKSHMI
Authorized Official - Last Name:SUNDARRAJ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-825-1654
Mailing Address - Street 1:33300 EGYPT LN
Mailing Address - Street 2:SUITE A400
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77354-2739
Mailing Address - Country:US
Mailing Address - Phone:281-825-1654
Mailing Address - Fax:281-259-0618
Practice Address - Street 1:33300 EGYPT LN
Practice Address - Street 2:SUITE A400
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77354-2739
Practice Address - Country:US
Practice Address - Phone:281-825-1654
Practice Address - Fax:281-259-0618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2830207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXM2830OtherPHYSICIAN LICENSE
TXM2830OtherPHYSICIAN LICENSE