Healthcare Provider Details

I. General information

NPI: 1386504561
Provider Name (Legal Business Name): SUNRISE PEDIATRIC CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2025
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 N STONE ST
DELAND FL
32720-0802
US

IV. Provider business mailing address

6219 WOODHAVEN VILLAGE DR
PORT ORANGE FL
32128-6850
US

V. Phone/Fax

Practice location:
  • Phone: 786-393-0315
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM3000X
TaxonomyMedically Fragile Infants and Children Day Care
License Number
License Number State

VIII. Authorized Official

Name: ANGELA HANSEN
Title or Position: OWNER
Credential:
Phone: 786-393-0315