Provider Demographics
NPI:1568409324
Name:LAIRD, SUNDAY NESBIT (PA-C)
Entity Type:Individual
Prefix:
First Name:SUNDAY
Middle Name:NESBIT
Last Name:LAIRD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SUNDAY
Other - Middle Name:
Other - Last Name:NESBIT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:321 N WARREN ST
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08618-4741
Mailing Address - Country:US
Mailing Address - Phone:609-278-5900
Mailing Address - Fax:609-695-3532
Practice Address - Street 1:1005 MAR WALT DRIVE
Practice Address - Street 2:NURSING HOME DEPARTMENT
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-6796
Practice Address - Country:US
Practice Address - Phone:850-863-8202
Practice Address - Fax:850-862-6148
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103475363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL292320300Medicaid
FL292320300Medicaid
FLQ13867Medicare UPIN