DR. MICHELLE K SUDO, DO - NPI NUMBER 1215905864

Summary

Provider Name: DR. MICHELLE K SUDO, DO

NPI Number: 1215905864

Clasification: Pediatrics (208000000X)

Address:
890 VIEWMONT DR
DICKSON CITY, PA
ZIP 18519

Phone Number: (570) 207-4360



Detailed Information

DR. Michelle K Sudo, DO is a pediatrician in Dickson City, PA. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. The assigned NPI number for this provider is 1215905864 and is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business address is:

890 VIEWMONT DR
DICKSON CITY, PA
ZIP 18519-699
Phone: (570) 207-4360
Fax: (570) 383-1940

The enumeration date for this NPI number is 3/9/2006 and was last updated on 8/14/2013.

Map - Location of Practice

Similar Providers

NPI Provider Name / Taxonomy
1023014644 FRANCIS DENNIS DAWGERT, MD
Pediatrics
1023199098 PEDIATRICS OF NORTHEASTERN PENNSYLVANIA PC
Pediatrics
1184764060 JOHN H MARX, MD
Pediatrics
1154594687 COMMUNITY MEDICAL CENTER
Pediatrics
1093953580 DR. LORI ANN SHIPSKY, M.D.
Pediatrics
1205811288 DR. ELIZABETH ESCALANTE, MD
Pediatrics (Neonatal-Perinatal Medicine)
1184957102 DR. MICHAEL ANTHONY MANDARANO, D.O.
Pediatrics





Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 208000000X Pediatrics OS009616L PA Yes

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 001677040 MEDICAID PA
2 G62024 MEDICARE UPIN PA

NPI Record

No. Field Name Field Value Field Definition 1
1 NPI 1215905864 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
2 Entity Type Code 1 Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
3 Provider Last Name Legal Name SUDO The last name of the provider. If the provider is an individual, this is the legal name.
4 Provider First Name MICHELLE The first name of the provider, if the provider is an individual.
5 Provider Middle Name K The middle name of the provider, if the provider is an individual.
6 Provider Name Prefix Text DR. The name prefix or salutation of the provider if the provider is an individual; for example, Mr., Mrs., or Corporal.
7 Provider Credential Text DO The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
8 Provider First Line Business Practice Location Address 890 VIEWMONT DR The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
9 Provider Business Practice Location Address City Name DICKSON CITY The city name in the location address of the provider being identified.
10 Provider Business Practice Location Address State Name PA The State code in the location of the provider being identified.
11 Provider Business Practice Location Address Postal Code 185191699 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
12 Provider Business Practice Location Address Country Code If outside U S US The country code in the location address of the provider being identified.
13 Provider Business Practice Location Address Telephone Number 5702074360 The telephone number associated with the location address of the provider being identified.
14 Provider Business Practice Location Address Fax Number 5703831940 The fax number associated with the location address of the provider being identified.
15 Provider Enumeration Date 3/9/2006 The date the provider was assigned a unique identifier (assigned an NPI).
16 Last Update Date 8/14/2013 The date that a record was last updated or changed.
17 Provider Gender Code F The code designating the provider’s gender if the provider is a person.
18 Healthcare Provider Taxonomy Code 1 208000000X Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
19 Provider License Number 1 OS009616L The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
20 Provider License Number State Code 1 PA The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
21 Healthcare Provider Primary Taxonomy Switch 1 Y
22 Other Provider Identifier 1 001677040 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
23 Other Provider Identifier Type Code 1 05 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
24 Other Provider Identifier State 1 PA
25 Other Provider Identifier 2 G62024 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
26 Other Provider Identifier Type Code 2 02 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
27 Other Provider Identifier State 2 PA
28 Is Sole Proprietor N Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No

Download Record

Download this NPI record in Text format: Export

Download this NPI record in Excel (CSV) format: Export

Download this NPI record in XML format: Export




This page was last updated on: 3/10/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.