Healthcare Provider Details

I. General information

NPI: 1457330060
Provider Name (Legal Business Name): AMANDA SUE CUDA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. AMANDA SUE MCGRAIL

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 POINT FOSDICK DRIVE NW SUITE 220 PENINSULA FAMILY MEDICAL CENTER
GIG HARBOR WA
98335
US

IV. Provider business mailing address

4700 POINT FOSDICK DRIVE NW SUITE 220 PENINSULA FAMILY MEDICAL CENTER
GIG HARBOR WA
98335
US

V. Phone/Fax

Practice location:
  • Phone: 253-851-5121
  • Fax: 253-851-3059
Mailing address:
  • Phone: 253-851-5121
  • Fax: 253-851-3059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number13083
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01060013A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD60463920
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: