Provider Demographics
NPI:1588929764
Name:SUNNYSIDE PEDIATRICS PLLC
Entity type:Organization
Organization Name:SUNNYSIDE PEDIATRICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:I
Authorized Official - Last Name:ACEVEDO-GRACIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-992-9383
Mailing Address - Street 1:5817 PATTON ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-2428
Mailing Address - Country:US
Mailing Address - Phone:361-992-9383
Mailing Address - Fax:
Practice Address - Street 1:5817 PATTON ST
Practice Address - Street 2:SUITE 101
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-2428
Practice Address - Country:US
Practice Address - Phone:361-992-9383
Practice Address - Fax:361-992-9543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-12
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2080P0205X, 363LF0000X, 363LP0200X
TXL9052208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric EndocrinologyGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Multi-Specialty