Healthcare Provider Details

I. General information

NPI: 1790466035
Provider Name (Legal Business Name): SUNRISE PSYCHIATRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2023
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 S DOBSON RD STE 213A
MESA AZ
85202-4767
US

IV. Provider business mailing address

1520 S DOBSON RD STE 213A
MESA AZ
85202-4767
US

V. Phone/Fax

Practice location:
  • Phone: 480-382-6982
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: TALLAN DEPRIEST
Title or Position: DIRECTOR
Credential:
Phone: 480-382-6982