Provider Demographics
NPI:1619394509
Name:SUNDBERG, ADRIENNE (AP)
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:
Last Name:SUNDBERG
Suffix:
Gender:F
Credentials:AP
Other - Prefix:
Other - First Name:ADRIENNE
Other - Middle Name:
Other - Last Name:BORDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AP
Mailing Address - Street 1:253 S LINKS AVE
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236-6926
Mailing Address - Country:US
Mailing Address - Phone:941-350-1014
Mailing Address - Fax:
Practice Address - Street 1:253 S LINKS AVE
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-6926
Practice Address - Country:US
Practice Address - Phone:941-350-1014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-28
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 1086171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist