| Sunrise Psychiatry Pllc | |
|
1520 S Dobson Rd Ste 213a Mesa AZ 85202-4767 | |
| (480) 382-6982 | |
| Not Available |
| Full Name | Sunrise Psychiatry Pllc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1520 S Dobson Rd Ste 213a, Mesa, Arizona |
| Authorized Official Name and Position | Tallan Depriest (DIRECTOR) |
| Authorized Official Contact | 4803826982 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sunrise Psychiatry Pllc 1520 S Dobson Rd Ste 213a Mesa AZ 85202-4767 Ph: () - | Sunrise Psychiatry Pllc 1520 S Dobson Rd Ste 213a Mesa AZ 85202-4767 Ph: (480) 382-6982 |
| NPI Number | 1790466035 |
|---|---|
| Provider Enumeration Date | 07/28/2023 |
| Last Update Date | 10/18/2023 |
| Certification Date | 10/18/2023 |
| Medicare PECOS PAC ID | 4486093267 |
|---|---|
| Medicare Enrollment ID | O20240412000823 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790466035 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Tallan T Depriest |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1548794399 PECOS PAC ID: 0547531105 Enrollment ID: I20211021002747 |
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