Provider Demographics
NPI:1417907429
Name:SUNRISE PEDIATRIC ASSOCIATES
Entity Type:Organization
Organization Name:SUNRISE PEDIATRIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:ALOYSIUS
Authorized Official - Last Name:DANNA
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:504-837-9000
Mailing Address - Street 1:3116 6TH STREET
Mailing Address - Street 2:SUITE 101
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-1713
Mailing Address - Country:US
Mailing Address - Phone:504-837-9000
Mailing Address - Fax:504-837-8293
Practice Address - Street 1:3116 6TH STREET
Practice Address - Street 2:SUITE 101
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-1713
Practice Address - Country:US
Practice Address - Phone:504-837-9000
Practice Address - Fax:504-837-8293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1940534Medicaid