Healthcare Provider Details

I. General information

NPI: 1831289610
Provider Name (Legal Business Name): SANDRA LYNN HUDAK DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 01/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2018 NAAMANS RD #1
WILMINGTON DE
19810-2659
US

IV. Provider business mailing address

2018 NAAMANS RD #1
WILMINGTON DE
19810-2659
US

V. Phone/Fax

Practice location:
  • Phone: 302-528-7964
  • Fax:
Mailing address:
  • Phone: 302-528-7964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE1-0000171
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: