{
"Npi": {
"NPI": "1033855648",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SUNRISE INTEGRATIVE HEALTH PLLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1201 KINGS HWY STE 2",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FAIRFIELD",
"MailingAddressStateName": "CT",
"MailingAddressPostalCode": "06824-5319",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "860-370-4186",
"MailingAddressFaxNumber": "203-643-2313",
"FirstLinePracticeLocationAddress": "2389 MAIN ST STE 100",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "GLASTONBURY",
"PracticeLocationAddressStateName": "CT",
"PracticeLocationAddressPostalCode": "06033-4617",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "860-370-4186",
"PracticeLocationAddressFaxNumber": "203-643-2313",
"EnumerationDate": "05/06/2022",
"LastUpdateDate": "07/25/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "QUAO",
"AuthorizedOfficialFirstName": "ANAICA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "DIRECTOR",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DNP, APRN",
"AuthorizedOfficialTelephoneNumber": "860-370-4186",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "363LF0000X",
"TaxonomyName": "Family Nurse Practitioner",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "261QH0100X",
"TaxonomyName": "Health Service Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}