Provider Demographics
NPI:1982593257
Name:SUNNY POPSICLE LLC
Entity type:Organization
Organization Name:SUNNY POPSICLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:STIVERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-603-5918
Mailing Address - Street 1:1850 BENNIGAN DR
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-8258
Mailing Address - Country:US
Mailing Address - Phone:330-488-4324
Mailing Address - Fax:
Practice Address - Street 1:7965 NORTH HIGH STREET SUITE 350
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235
Practice Address - Country:US
Practice Address - Phone:330-488-4324
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-01
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty