Provider Demographics
NPI:1598215899
Name:BUNDOTICH, SYLVIA (APRN)
Entity Type:Individual
Prefix:
First Name:SYLVIA
Middle Name:
Last Name:BUNDOTICH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1053 CENTER STREET
Mailing Address - Street 2:SC HOUSE CALLS INC
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169
Mailing Address - Country:US
Mailing Address - Phone:800-491-0909
Mailing Address - Fax:855-632-8329
Practice Address - Street 1:1109 MEDICAL CENTER DRIVE, SUITE A2
Practice Address - Street 2:SC HOUSE CALLS INC
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909
Practice Address - Country:US
Practice Address - Phone:800-491-0909
Practice Address - Fax:855-632-8329
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-11
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY3010531363LF0000X
GARN285818363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100477710Medicaid
13909647OtherCAQH