Healthcare Provider Details

I. General information

NPI: 1144452079
Provider Name (Legal Business Name): SUNRISE PEDIATRICS, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2009
Last Update Date: 10/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 S LINDSAY RD STE # 126
GILBERT AZ
85297-1506
US

IV. Provider business mailing address

4100 S LINDSAY RD STE # 126
GILBERT AZ
85297-1506
US

V. Phone/Fax

Practice location:
  • Phone: 480-892-3500
  • Fax: 480-664-3632
Mailing address:
  • Phone: 480-892-3500
  • Fax: 480-664-3632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number34629
License Number StateAZ

VIII. Authorized Official

Name: DR. SANJAY J SHAH
Title or Position: MANAGER
Credential: M.D.
Phone: 480-892-3500