MEDICARE: SUNRISE DAY CAMP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QX0200X	Oncology Clinic/Center	704160	NY

General Provider Information

NPI Number	:	1841640638
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNRISE DAY CAMP

Provider Business Mailing Address
First Line	:	15 NEIL CT
Second Line	:
City	:	OCEANSIDE
State	:	NY
Zip	:	11572-5815
Country	:	US
Telephone Number	:	631-920-6439
Fax Number	:

Provider Business Practice Location Address
First Line	:	75 COLONIAL SPRINGS RD
Second Line	:
City	:	WHEATLEY HEIGHTS
State	:	NY
Zip	:	11798-1014
Country	:	US
Telephone Number	:	631-920-6439
Fax Number	:

Authorized Official
Title or Position	:	NURSE COORDINATOR
Name	:	MRS. AVA DAWSON
Credential	:	CPNP-PC
Telephone Number	:	347-371-0323

Provider Enumeration Date	:	06/13/2016
Last Update Date	:	06/13/2016

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Directions to “SUNRISE DAY CAMP ” Practice Location

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