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General NPI Number Information
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NPI Number | 1891939989
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Entity Type | Organization
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Legal Business Name | SUNRISE PEDIATRICS LLC
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Dates
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Enumeration Date | 04/21/2009
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Last Update Date | 11/27/2025
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Provider Practice Location Address
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Address Line | 25103 HWY 27
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City | LAKE WALES
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State | FL
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Zip | 33859-6843
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Country | US
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Telephone | 863-734-0344
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Fax | 877-658-8666
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Provider Business Mailing Address
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Address Line | 25103 HWY 27
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City | LAKE WALES
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State | FL
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Zip | 33859-6843
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Country | US
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Telephone | 863-734-0344
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Fax | 877-658-8666
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Authorized Official
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Title or Position | OWNER
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Name | JAGDEEP PRUTHI
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Credential | MD
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Telephone | 863-734-0344
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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 |
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License Number State |
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