Provider Demographics
NPI:1407896160
Name:SUDUIKIS, SANDRA VERONICA (MD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:VERONICA
Last Name:SUDUIKIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 BROOK ST
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:MA
Mailing Address - Zip Code:01741-1608
Mailing Address - Country:US
Mailing Address - Phone:617-876-4344
Mailing Address - Fax:
Practice Address - Street 1:1575 CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-4308
Practice Address - Country:US
Practice Address - Phone:617-876-4344
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA76458174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA725372OtherTUFTS
MA133800OtherHEALTHSOURCE
MAJ12920OtherBLUE CROSS BLUE SHIELD
MAS022064OtherTRICARE
MA3097501Medicaid
MA022064OtherCHAMPUS
MA80137OtherHARVARD PILGRIM
MA022064OtherCHAMPUS
MA725372OtherTUFTS