Basic Information
| Provider Information | |||||||||
| NPI: | 1417907429 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUNRISE PEDIATRIC ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3116 6TH STREET | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | METAIRIE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700021713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5048379000 | ||||||||
| FaxNumber: | 5048378293 | ||||||||
| Practice Location | |||||||||
| Address1: | 3116 6TH STREET | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | METAIRIE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700021713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5048379000 | ||||||||
| FaxNumber: | 5048378293 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | DANNA | ||||||||
| AuthorizedOfficialFirstName: | NICHOLAS | ||||||||
| AuthorizedOfficialMiddleName: | ALOYSIUS | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 5048379000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | III | ||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 1940534 | 05 | LA | MEDICAID |