Healthcare Provider Details

I. General information

NPI: 1386442481
Provider Name (Legal Business Name): NADYIA JANE EYRE SUDPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2025
Last Update Date: 03/04/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12715 E MISSION AVE
SPOKANE VALLEY WA
99216-1027
US

IV. Provider business mailing address

12715 E MISSION AVE
SPOKANE VALLEY WA
99216-1027
US

V. Phone/Fax

Practice location:
  • Phone: 509-232-5766
  • Fax:
Mailing address:
  • Phone: 509-389-1666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number61613997
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: