Healthcare Provider Details

I. General information

NPI: 1831219948
Provider Name (Legal Business Name): SUNRISE CARDIOLOGY ASSOC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8393 W OAKLAND PARK BLVD
SUNRISE FL
33351-7307
US

IV. Provider business mailing address

8393 W OAKLAND PARK BLVD
SUNRISE FL
33351-7307
US

V. Phone/Fax

Practice location:
  • Phone: 954-741-3335
  • Fax: 954-746-9475
Mailing address:
  • Phone: 954-741-3335
  • Fax: 954-746-9475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MERRY WAJDA
Title or Position: OFFICE MANAGER
Credential:
Phone: 954-741-3335