Provider Demographics
NPI:1437314440
Name:SUDORE, TRACY ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:ELIZABETH
Last Name:SUDORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5100 W TAFT RD
Mailing Address - Street 2:STE 2E
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-3807
Mailing Address - Country:US
Mailing Address - Phone:315-634-3399
Mailing Address - Fax:315-634-3395
Practice Address - Street 1:5100 WEST TAFT RD
Practice Address - Street 2:STE 2E
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088
Practice Address - Country:US
Practice Address - Phone:315-634-3399
Practice Address - Fax:315-634-3395
Is Sole Proprietor?:No
Enumeration Date:2008-07-20
Last Update Date:2013-01-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY241964-1208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery