Healthcare Provider Details

I. General information

NPI: 1366211724
Provider Name (Legal Business Name): CATHERINE SUNDHOLM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2023
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 BERDAN AVE
WAYNE NJ
07470-3236
US

IV. Provider business mailing address

PO BOX 416457
BOSTON MA
02241-6457
US

V. Phone/Fax

Practice location:
  • Phone: 201-612-9988
  • Fax: 201-445-9050
Mailing address:
  • Phone: 844-362-1735
  • Fax: 973-290-7495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00809900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: