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NPI Code Detail

MEDICARE: SAMANTHA SUDANO

MEDICARE: SAMANTHA SUDANO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor006970NY
2101YP2500XProfessional CounselorC6199OR

General Provider Information

NPI Number : 1316346398
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMANTHA SUDANO
Provider Business Mailing Address
First Line : 5525 E BURNSIDE ST
Second Line :
City : PORTLAND
State : OR
Zip : 97215-1258
Country : US
Telephone Number : 541-936-9783
Fax Number :
Provider Business Practice Location Address
First Line : 5525 E BURNSIDE ST
Second Line :
City : PORTLAND
State : OR
Zip : 97215-1258
Country : US
Telephone Number : 541-936-9783
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2014
Last Update Date : 11/14/2025

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Directions to “ SAMANTHA SUDANO ” Practice Location

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