Provider Demographics
NPI:1114630472
Name:TIWADE, SUNDEEP D (ND)
Entity Type:Individual
Prefix:
First Name:SUNDEEP
Middle Name:D
Last Name:TIWADE
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11990 VILLAGE CIR
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65401-4580
Mailing Address - Country:US
Mailing Address - Phone:314-465-0469
Mailing Address - Fax:
Practice Address - Street 1:704 HISTORIC ROUTE 66
Practice Address - Street 2:SUITE 207
Practice Address - City:WAYNESVILLE
Practice Address - State:MO
Practice Address - Zip Code:65583
Practice Address - Country:US
Practice Address - Phone:573-774-8494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-03
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath