Provider Demographics
NPI:1568409324
Name:LAIRD, SUNDAY NESBIT (PA-C)
Entity type:Individual
Prefix:
First Name:SUNDAY
Middle Name:NESBIT
Last Name:LAIRD
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:SUNDAY
Other - Middle Name:
Other - Last Name:NESBIT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:733 DENISE DR
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32536-5423
Mailing Address - Country:US
Mailing Address - Phone:202-427-5554
Mailing Address - Fax:
Practice Address - Street 1:733 DENISE DR
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536-5423
Practice Address - Country:US
Practice Address - Phone:202-427-5554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103475363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL292320300Medicaid
FL292320300Medicaid
FLQ13867Medicare UPIN