Provider Demographics
NPI:1912524687
Name:SUNDARAM, JUDI (NP)
Entity Type:Individual
Prefix:
First Name:JUDI
Middle Name:
Last Name:SUNDARAM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2854 PADDOCK WAY
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-3457
Mailing Address - Country:US
Mailing Address - Phone:617-930-1371
Mailing Address - Fax:
Practice Address - Street 1:SF SUNSET
Practice Address - Street 2:595 BUCKINGHAM WAY, SUITE 343
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94132-3045
Practice Address - Country:US
Practice Address - Phone:650-681-8868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-29
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2302318363LP0808X
CA95017148363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health