Provider Demographics
NPI:1548743214
Name:SUDAH, SARAH
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:SUDAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 BUCKINGHAM RD APT 1534
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-5792
Mailing Address - Country:US
Mailing Address - Phone:469-450-7313
Mailing Address - Fax:
Practice Address - Street 1:411 BUCKINGHAM RD APT 1534
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-5792
Practice Address - Country:US
Practice Address - Phone:469-450-7313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-10
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX940458163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse