Provider Demographics
NPI:1124901368
Name:SUNRISE REDSTONE PLLC
Entity type:Organization
Organization Name:SUNRISE REDSTONE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANZANARES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:813-822-0477
Mailing Address - Street 1:4062 CLOUD HOPPER WAY
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33559-6933
Mailing Address - Country:US
Mailing Address - Phone:843-338-0023
Mailing Address - Fax:
Practice Address - Street 1:16238 REDSTONE WAY
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:FL
Practice Address - Zip Code:33556-4668
Practice Address - Country:US
Practice Address - Phone:813-822-0477
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-28
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental