Provider Demographics
NPI:1609883768
Name:CLELAND ZAMUDIO, SUZANNE S (MD)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:S
Last Name:CLELAND ZAMUDIO
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 1:100 E. JACKSON AVENUE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ELLENSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:98926
Mailing Address - Country:US
Mailing Address - Phone:509-933-8860
Mailing Address - Fax:509-339-8870
Practice Address - Street 1:100 E JACKSON AVE STE 102
Practice Address - Street 2:
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-3693
Practice Address - Country:US
Practice Address - Phone:509-933-8860
Practice Address - Fax:509-933-8870
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD21133207Y00000X
WAMD00038929208600000X, 207Y00000X
ORMD 21133208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR151216Medicaid
OR151216Medicaid
OR104863Medicare ID - Type Unspecified
OR104863Medicare ID - Type Unspecified
ORF91457Medicare UPIN