1730477985 NPI number — MS. SUNDY LYNN ANDERSON MA

Table of content: MR. SHANE LEDREW FINK LPTA (NPI 1477835213)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730477985 NPI number — MS. SUNDY LYNN ANDERSON MA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANDERSON
Provider First Name:
SUNDY
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730477985
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 82819
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97282-0819
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-233-5405
Provider Business Mailing Address Fax Number:
503-233-2694

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7455 SW BEVELAND RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TIGARD
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97223-8610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-624-2600
Provider Business Practice Location Address Fax Number:
503-624-7752
Provider Enumeration Date:
07/20/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: R0000WDBCH . This is a "MEDICARE GROUP" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




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