Healthcare Provider Details

I. General information

NPI: 1679869069
Provider Name (Legal Business Name): LEANNA SUDHOF MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2011
Last Update Date: 10/23/2023
Certification Date: 10/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4860 Y ST STE 2500
SACRAMENTO CA
95817-2307
US

IV. Provider business mailing address

561 PICO WAY
SACRAMENTO CA
95819-2927
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-6900
  • Fax:
Mailing address:
  • Phone: 469-774-8453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number263450
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberC191249
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: