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General NPI Number Information
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NPI Number | 1407896160
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Entity Type | Individual
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Provider Name | SANDRA VERONICA SUDUIKIS MD
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Gender | Female
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Dates
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Enumeration Date | 06/08/2006
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Last Update Date | 12/17/2024
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Provider Practice Location Address
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Address Line | 1575 CAMBRIDGE ST
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City | CAMBRIDGE
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State | MA
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Zip | 02138-4308
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Country | US
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Telephone | 617-876-4344
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Fax |
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Provider Business Mailing Address
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Address Line | 55 FRUIT ST
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City | BOSTON
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State | MA
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Zip | 02114-2621
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Country | US
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Telephone | 617-349-5706
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Fax |
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 76458
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MA76458
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License Number State | MA
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