Provider Demographics
NPI:1447505441
Name:SUNNY, CICILY
Entity type:Individual
Prefix:MRS
First Name:CICILY
Middle Name:
Last Name:SUNNY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:289 BIDWELL AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-3150
Mailing Address - Country:US
Mailing Address - Phone:718-619-5013
Mailing Address - Fax:
Practice Address - Street 1:289 BIDWELL AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-3150
Practice Address - Country:US
Practice Address - Phone:718-619-5013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-17
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist