Provider Demographics
NPI:1790466035
Name:SUNRISE PSYCHIATRY PLLC
Entity Type:Organization
Organization Name:SUNRISE PSYCHIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TALLAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEPRIEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-382-6982
Mailing Address - Street 1:1520 S DOBSON RD STE 213A
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-4767
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1520 S DOBSON RD STE 213A
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-4767
Practice Address - Country:US
Practice Address - Phone:480-382-6982
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-28
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty