Provider Demographics
NPI:1487226411
Name:SOMASUNDARAM, SOUNDARYA (PA-C)
Entity Type:Individual
Prefix:
First Name:SOUNDARYA
Middle Name:
Last Name:SOMASUNDARAM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 PACIFIC AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-4381
Mailing Address - Country:US
Mailing Address - Phone:253-300-8453
Mailing Address - Fax:206-590-5919
Practice Address - Street 1:1201 PACIFIC AVE STE 400
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-4381
Practice Address - Country:US
Practice Address - Phone:253-300-8453
Practice Address - Fax:206-590-5919
Is Sole Proprietor?:No
Enumeration Date:2021-07-09
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPABP.BG.61195408363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant