Provider Demographics
NPI:1285406199
Name:SUNLIFE PSYCHOLOGY
Entity type:Organization
Organization Name:SUNLIFE PSYCHOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:KEDEM
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:646-942-1531
Mailing Address - Street 1:558154 LUDLAM STATION
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33255
Mailing Address - Country:US
Mailing Address - Phone:305-859-1709
Mailing Address - Fax:
Practice Address - Street 1:3550 BISCAYNE BLVD STE 305
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-3853
Practice Address - Country:US
Practice Address - Phone:646-942-1531
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty