Provider Demographics
NPI:1780450015
Name:SUNDERLAND, KYLAR A
Entity type:Individual
Prefix:
First Name:KYLAR
Middle Name:A
Last Name:SUNDERLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 W SOUTH BOUNDARY ST STE 6
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-5101
Mailing Address - Country:US
Mailing Address - Phone:419-936-4241
Mailing Address - Fax:
Practice Address - Street 1:118 W SOUTH BOUNDARY ST STE 6
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-5101
Practice Address - Country:US
Practice Address - Phone:419-936-4241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-28
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty