| Doctor Name: | SANDRA Y SUDERMAN |
| NPI Number: | 1679666077 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | ARNP |
| License Number: | 44574 |
| Business Practice Address: | 913 Sheidley Ave Bonner Springs, KS - 660129514 |
| Business Phone Number: | 9133227222 |
| Business Fax Number: | 9133227284 |
| Mailing Address: | 8929 Parallel Pkwy, Pmg Physician Credentialing KANSAS CITY |
| State: | KS |
| Postal Code: | 661121689 |
| Phone Number: | 9135963893 |
| Fax Number: | 5738938581 |
| NPI Enumeration Date: | 09/30/2006 |
| NPI Last Update Date: | 03/09/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 44574 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KS |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |