Provider Demographics
NPI:1578722716
Name:SUNRISE PEDIATRICS
Entity Type:Organization
Organization Name:SUNRISE PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTIONER/OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:
Authorized Official - Last Name:CONNELLY-KATZ
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:585-244-5200
Mailing Address - Street 1:2225 S CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-2664
Mailing Address - Country:US
Mailing Address - Phone:585-244-5200
Mailing Address - Fax:585-244-5202
Practice Address - Street 1:2225 S CLINTON AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-2664
Practice Address - Country:US
Practice Address - Phone:585-244-5200
Practice Address - Fax:585-244-5202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY168360-1208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty