MEDICARE: DR. SUNDRAYAH NICOLE STOLLER M.D.

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
1	207L00000X	Anesthesiology Physician	8087	AK
2	207L00000X	Anesthesiology Physician	256171	MA
3	207LP3000X	Pediatric Anesthesiology Physician	8087	AK

General Provider Information

NPI Number	:	1962631853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUNDRAYAH NICOLE STOLLER M.D.

Provider Business Mailing Address
First Line	:	3300 PROVIDENCE DRIVE, SUITE 207
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99508
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3300 PROVIDENCE DR STE 207
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99508-4620
Country	:	US
Telephone Number	:	907-279-0555
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2009
Last Update Date	:	12/11/2014

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