MEDICARE: OLIVIA SUNDMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1487538021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLIVIA SUNDMAN

Provider Business Mailing Address
First Line	:	99 WESTEDGE ST APT 336
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29403-4986
Country	:	US
Telephone Number	:	636-795-8138
Fax Number	:

Provider Business Practice Location Address
First Line	:	99 WESTEDGE ST APT 336
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29403-4986
Country	:	US
Telephone Number	:	636-795-8138
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2025
Last Update Date	:	08/05/2025

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Directions to “ OLIVIA SUNDMAN ” Practice Location

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