Provider Demographics
NPI:1396875134
Name:SYKURSKI, SUZANNE LYNN (NMD)
Entity type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:LYNN
Last Name:SYKURSKI
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1975
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-0084
Mailing Address - Country:US
Mailing Address - Phone:425-890-2072
Mailing Address - Fax:425-642-3220
Practice Address - Street 1:535 E SUNSET WAY STE B
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-3473
Practice Address - Country:US
Practice Address - Phone:425-890-2072
Practice Address - Fax:425-642-3220
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT00001351175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA3580SYOtherREGENCE RIDER #
WA09823OtherFCHN CONTROL#