Provider Demographics
NPI:1366558025
Name:SUNSHINE PEDIATRICS & ADOLESCENT CARE, P.A.
Entity type:Organization
Organization Name:SUNSHINE PEDIATRICS & ADOLESCENT CARE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONSULTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:W
Authorized Official - Last Name:GILLIKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MBA
Authorized Official - Phone:252-353-7162
Mailing Address - Street 1:PO BOX 30696
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27833-0696
Mailing Address - Country:US
Mailing Address - Phone:252-353-7162
Mailing Address - Fax:252-353-1760
Practice Address - Street 1:1631 MIDTOWN PL
Practice Address - Street 2:SUITE 107
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-1300
Practice Address - Country:US
Practice Address - Phone:919-876-1515
Practice Address - Fax:919-876-5656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8977389Medicaid
NC8977389Medicaid