Provider Demographics
NPI:1194118307
Name:SUNSHINE INFANTS AND TODDLERS EARLY INTERVENTION PROGRAM, LLC
Entity type:Organization
Organization Name:SUNSHINE INFANTS AND TODDLERS EARLY INTERVENTION PROGRAM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/SLP
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:TYLER
Authorized Official - Last Name:SEYMORE-COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:718-671-6885
Mailing Address - Street 1:120 ELGAR PL APT 3K
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-5149
Mailing Address - Country:US
Mailing Address - Phone:718-671-6885
Mailing Address - Fax:
Practice Address - Street 1:120 ELGAR PL APT 3K
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-5149
Practice Address - Country:US
Practice Address - Phone:718-671-6885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-12
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009439252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency