Provider Demographics
NPI:1427649169
Name:RAVESH, SUNNY M
Entity type:Individual
Prefix:
First Name:SUNNY
Middle Name:M
Last Name:RAVESH
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 1:55 ANDOVER RD
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-1801
Mailing Address - Country:US
Mailing Address - Phone:516-957-1234
Mailing Address - Fax:
Practice Address - Street 1:55 ANDOVER RD
Practice Address - Street 2:
Practice Address - City:ROSLYN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11577-1801
Practice Address - Country:US
Practice Address - Phone:516-957-1234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-26
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ86074704133V00000X
NY011249-01133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered