Healthcare Provider Details

I. General information

NPI: 1578586962
Provider Name (Legal Business Name): SANDRA S VERMEULEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 04/23/2021
Certification Date: 04/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 17TH AVE STE A10 C/O SWEDISH RADIOSURGERY CENTER AT CHERRY HILL
SEATTLE WA
98122-5789
US

IV. Provider business mailing address

PO BOX 749730
LOS ANGELES CA
90074-9730
US

V. Phone/Fax

Practice location:
  • Phone: 206-320-7130
  • Fax: 206-320-7137
Mailing address:
  • Phone: 206-971-0034
  • Fax: 206-215-4351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberMD00023801
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: