Healthcare Provider Details

I. General information

NPI: 1144144130
Provider Name (Legal Business Name): UNKNOWN SUNDAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 PRESIDENTIAL PLZ APT 2109
SYRACUSE NY
13202-2313
US

IV. Provider business mailing address

50 PRESIDENTIAL PLZ APT 2109
SYRACUSE NY
13202-2313
US

V. Phone/Fax

Practice location:
  • Phone: 315-680-2050
  • Fax:
Mailing address:
  • Phone: 315-680-2050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: