Provider Demographics
NPI:1144563255
Name:SUNDELL, SEYMOUR ZANE (MD)
Entity Type:Individual
Prefix:DR
First Name:SEYMOUR
Middle Name:ZANE
Last Name:SUNDELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 N. JUANITA AVE
Mailing Address - Street 2:UNIT B
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277
Mailing Address - Country:US
Mailing Address - Phone:303-918-0131
Mailing Address - Fax:
Practice Address - Street 1:867 COUNTY RD 85
Practice Address - Street 2:
Practice Address - City:TABERNASH
Practice Address - State:CO
Practice Address - Zip Code:80478-0460
Practice Address - Country:US
Practice Address - Phone:303-918-0131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-27
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO187022084F0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry