Provider Demographics
NPI:1174823512
Name:MATTHEWS, SUNDARI TENESHIA (RN)
Entity Type:Individual
Prefix:
First Name:SUNDARI
Middle Name:TENESHIA
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17824 EAST PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44119
Mailing Address - Country:US
Mailing Address - Phone:216-322-4450
Mailing Address - Fax:
Practice Address - Street 1:17824 E PARK DR
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44119-2012
Practice Address - Country:US
Practice Address - Phone:216-322-4450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH365089163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse