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General NPI Number Information
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NPI Number | 1578722716
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Entity Type | Organization
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Legal Business Name | SUNRISE PEDIATRICS
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Dates
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Enumeration Date | 06/03/2008
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Last Update Date | 06/03/2008
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Provider Practice Location Address
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Address Line | 2225 S CLINTON AVE
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City | ROCHESTER
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State | NY
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Zip | 14618-2664
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Country | US
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Telephone | 585-244-5200
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Fax | 585-244-5202
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Provider Business Mailing Address
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Address Line | 2225 S CLINTON AVE
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City | ROCHESTER
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State | NY
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Zip | 14618-2664
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Country | US
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Telephone | 585-244-5200
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Fax | 585-244-5202
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Authorized Official
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Title or Position | NURSE PRACTIONER/OFFICE MANAGER
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Name | SALLY CONNELLY-KATZ
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Credential | F.N.P
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Telephone | 585-244-5200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 168360-1
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License Number State | NY
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