Healthcare Provider Details

I. General information

NPI: 1275144164
Provider Name (Legal Business Name): SUNDUS SABRIE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2020
Last Update Date: 08/13/2020
Certification Date: 08/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17705 HUTCHINS DR STE 250
MINNETONKA MN
55345-4103
US

IV. Provider business mailing address

17705 HUTCHINS DR STE 250
MINNETONKA MN
55345-4103
US

V. Phone/Fax

Practice location:
  • Phone: 952-401-8300
  • Fax:
Mailing address:
  • Phone: 952-401-8300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1427027184
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: