Healthcare Provider Details

I. General information

NPI: 1588704415
Provider Name (Legal Business Name): ELIZABETH SUNDE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 07/22/2021
Certification Date: 07/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10030 WARD
CHAPEL HILL NC
27517-7335
US

IV. Provider business mailing address

10030 WARD
CHAPEL HILL NC
27517-7335
US

V. Phone/Fax

Practice location:
  • Phone: 616-555-1234
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number4301081302
License Number StateMI

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: