Provider Demographics
NPI:1275814063
Name:SUNDINA, NATALIYA VIKTOROVNA (PA)
Entity Type:Individual
Prefix:MRS
First Name:NATALIYA
Middle Name:VIKTOROVNA
Last Name:SUNDINA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FRANCONIA
Mailing Address - State:NH
Mailing Address - Zip Code:03580
Mailing Address - Country:US
Mailing Address - Phone:907-581-1202
Mailing Address - Fax:
Practice Address - Street 1:155 MAIN STREET
Practice Address - Street 2:
Practice Address - City:FRANCONIA
Practice Address - State:NH
Practice Address - Zip Code:03580
Practice Address - Country:US
Practice Address - Phone:603-823-7078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-07
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2142363A00000X
NH0993363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant