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General NPI Number Information
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NPI Number | 1164646485
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Entity Type | Individual
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Provider Name | SHARON W SU M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 08/05/2018
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Provider Practice Location Address
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Address Line | 501 N GRAHAM ST SUITE 315
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City | PORTLAND
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State | OR
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Zip | 97227
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Country | US
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Telephone | 503-413-3090
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Fax | 503-413-3948
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Provider Business Mailing Address
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Address Line | 501 N GRAHAM ST STE 355
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City | PORTLAND
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State | OR
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Zip | 97227-2005
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Country | US
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Telephone | 503-413-3926
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Fax | 503-413-3927
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0210X
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Taxonomy Name | Pediatric Nephrology Physician
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License Number | MD12760
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License Number State | RI
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