Provider Demographics
NPI:1831219948
Name:SUNRISE CARDIOLOGY ASSOC.
Entity type:Organization
Organization Name:SUNRISE CARDIOLOGY ASSOC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:WAJDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-741-3335
Mailing Address - Street 1:8393 W OAKLAND PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-7307
Mailing Address - Country:US
Mailing Address - Phone:954-741-3335
Mailing Address - Fax:954-746-9475
Practice Address - Street 1:8393 W OAKLAND PARK BLVD
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-7307
Practice Address - Country:US
Practice Address - Phone:954-741-3335
Practice Address - Fax:954-746-9475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK3961Medicare ID - Type Unspecified