Provider Demographics
NPI:1760699136
Name:SUNRISE PEDIATRICS PC
Entity Type:Organization
Organization Name:SUNRISE PEDIATRICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MILKA
Authorized Official - Middle Name:
Authorized Official - Last Name:VELAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-777-7781
Mailing Address - Street 1:14 PHILADELPHIA AVE
Mailing Address - Street 2:
Mailing Address - City:SHILLINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19607-2757
Mailing Address - Country:US
Mailing Address - Phone:610-777-7781
Mailing Address - Fax:610-777-1275
Practice Address - Street 1:14 PHILADELPHIA AVE
Practice Address - Street 2:
Practice Address - City:SHILLINGTON
Practice Address - State:PA
Practice Address - Zip Code:19607-2757
Practice Address - Country:US
Practice Address - Phone:610-777-7781
Practice Address - Fax:610-777-1275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD062035-L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty