Provider Demographics
NPI:1932196870
Name:SUNDSTROM, ALAYNE K (DO)
Entity Type:Individual
Prefix:DR
First Name:ALAYNE
Middle Name:K
Last Name:SUNDSTROM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:601 STADIUM MALL DR
Mailing Address - Street 2:
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47907-2052
Mailing Address - Country:US
Mailing Address - Phone:765-494-1700
Mailing Address - Fax:765-496-1227
Practice Address - Street 1:601 STADIUM MALL DR
Practice Address - Street 2:
Practice Address - City:WEST LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47907-2052
Practice Address - Country:US
Practice Address - Phone:765-494-1700
Practice Address - Fax:765-496-1227
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN99017807A208D00000X
IN02002982A208D00000X
OH34-00-7104-S208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice