Provider Demographics
NPI:1831289610
Name:HUDAK, SANDRA LYNN (DPM)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:LYNN
Last Name:HUDAK
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2018 NAAMANS RD
Mailing Address - Street 2:#1
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-2659
Mailing Address - Country:US
Mailing Address - Phone:302-528-7964
Mailing Address - Fax:
Practice Address - Street 1:2018 NAAMANS RD
Practice Address - Street 2:#1
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-2659
Practice Address - Country:US
Practice Address - Phone:302-528-7964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEE1-0000171213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEU77292Medicare UPIN