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General NPI Number Information
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NPI Number | 1912524687
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Entity Type | Individual
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Provider Name | JUDI SUNDARAM NP
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Gender | Female
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Dates
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Enumeration Date | 06/29/2020
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Last Update Date | 04/16/2025
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Provider Practice Location Address
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Address Line | 2105 MARTIN LUTHER KING JR WAY FL 1
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City | BERKELEY
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State | CA
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Zip | 94704-1108
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Country | US
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Telephone | 888-588-8995
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Fax | 518-756-0812
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Provider Business Mailing Address
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Address Line | 3069 E KYNE ST APT 107
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City | SAN MATEO
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State | CA
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Zip | 94403-3676
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Country | US
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Telephone | 617-930-1371
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 95017148
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 2302318
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License Number State | MA
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