Provider Demographics
NPI:1649435504
Name:MUNDY GOODEN, SANDRA LYNN (SA C SURGICAL ASSIST)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:LYNN
Last Name:MUNDY GOODEN
Suffix:
Gender:F
Credentials:SA C SURGICAL ASSIST
Other - Prefix:MISS
Other - First Name:SANDRA
Other - Middle Name:LYNN
Other - Last Name:MUNDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12300 MCCRACKEN RD
Mailing Address - Street 2:MARYMOUNT HOSPITAL
Mailing Address - City:GARFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125-2914
Mailing Address - Country:US
Mailing Address - Phone:216-587-8200
Mailing Address - Fax:216-587-6715
Practice Address - Street 1:12300 MCCRACKEN RD
Practice Address - Street 2:MARYMOUNT HOSPITAL
Practice Address - City:GARFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44125-2914
Practice Address - Country:US
Practice Address - Phone:216-587-8200
Practice Address - Fax:216-587-6715
Is Sole Proprietor?:No
Enumeration Date:2008-07-21
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH078114363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical