1841740289 NPI number — SUNDOS FADEL PA

Table of content: SUNDOS FADEL PA (NPI 1841740289)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841740289 NPI number — SUNDOS FADEL PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FADEL
Provider First Name:
SUNDOS
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA
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:
1841740289
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/17/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19855 OUTER DR STE 207W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEARBORN
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48124-2193
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-327-0044
Provider Business Mailing Address Fax Number:
313-347-9026

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
43347 RIVERBRIDGE CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NOVI
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48375-4722
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-327-0044
Provider Business Practice Location Address Fax Number:
313-327-0044
Provider Enumeration Date:
10/10/2016

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: 363AM0700X , with the licence number:  5601007985 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1841740289 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2026 www.npivalidator.com