Provider Demographics
NPI:1790460038
Name:SUDAISAR POLYGRAPH & FORENSIC ASSESSMENTS, LLC
Entity Type:Organization
Organization Name:SUDAISAR POLYGRAPH & FORENSIC ASSESSMENTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:DESI
Authorized Official - Last Name:SUDAISAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-349-5828
Mailing Address - Street 1:PO BOX 1238
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-8238
Mailing Address - Country:US
Mailing Address - Phone:503-349-5828
Mailing Address - Fax:
Practice Address - Street 1:22350 SW PINE ST
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:OR
Practice Address - Zip Code:97140-9075
Practice Address - Country:US
Practice Address - Phone:503-349-5828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUDAISAR POLYGRAPH & FORENSIC ASSESSMENTS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes405300000XOther Service ProvidersPrevention ProfessionalGroup - Single Specialty