Healthcare Provider Details

I. General information

NPI: 1285089060
Provider Name (Legal Business Name): SUNRISE APS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2016
Last Update Date: 10/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2177 N UNIVERSITY DR
SUNRISE FL
33322-3938
US

IV. Provider business mailing address

2500 MAITLAND CENTER PARKWAY, SUITE 250
MAITLAND FL
32751
US

V. Phone/Fax

Practice location:
  • Phone: 754-216-5003
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JOHN STEIBRUN
Title or Position: CEO
Credential:
Phone: 407-351-7080