Healthcare Provider Details

I. General information

NPI: 1528480258
Provider Name (Legal Business Name): URSZULA ELIZABETH SUND ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2014
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

826 CLEARWATER AVE
SATELLITE BEACH FL
32937-4845
US

IV. Provider business mailing address

101 NICOLLS RD HOSPITAL T- 18030, HEALTH SCIENCE CENTER
STONY BROOK NY
11794-8183
US

V. Phone/Fax

Practice location:
  • Phone: 631-258-3969
  • Fax:
Mailing address:
  • Phone: 631-444-3577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number408380
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11047053
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number3066601
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: