Healthcare Provider Details

I. General information

NPI: 1841915568
Provider Name (Legal Business Name): SUNRISE LABORATORIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2022
Last Update Date: 10/05/2022
Certification Date: 10/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 HARTNESS RD
STATESVILLE NC
28677-3425
US

IV. Provider business mailing address

3500 WESTGATE DR STE 604
DURHAM NC
27707-2534
US

V. Phone/Fax

Practice location:
  • Phone: 919-451-6337
  • Fax:
Mailing address:
  • Phone: 919-451-6337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207KI0005X
TaxonomyClinical & Laboratory Immunology (Allergy & Immunology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: ANYA ODIM
Title or Position: CEO
Credential:
Phone: 919-451-6337