1134191992 NPI number — MRS. LAKESHA I LORD-SUNAMOTO MS OTR/L, CLT

Table of content: MRS. LAKESHA I LORD-SUNAMOTO MS OTR/L, CLT (NPI 1134191992)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134191992 NPI number — MRS. LAKESHA I LORD-SUNAMOTO MS OTR/L, CLT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LORD-SUNAMOTO
Provider First Name:
LAKESHA
Provider Middle Name:
I
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS OTR/L, CLT
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:
1134191992
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/26/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2412 E 13TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VANCOUVER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98661-4702
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-539-9202
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
231 FARMINGTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FARMINGTON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06032-1915
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-677-0005
Provider Business Practice Location Address Fax Number:
860-677-2727
Provider Enumeration Date:
02/06/2006

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: 174400000X , with the licence number:  002842 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0011116 . This is a "HEALTHNET" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 753168105 . This is a "NORTHEAST HEALTHCARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 7788774 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 11116 . This is a "CIGNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 11544836 . This is a "PROVIDER CAQH ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 130002842CT01 . This is a "ANTHEM BLUE CROSS BLUE SH" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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