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

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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
1 NPI 1215905864
2 Entity Type Code 1
3 Provider Last Name Legal Name SUDO
4 Provider First Name MICHELLE
5 Provider Middle Name K
6 Provider Name Prefix Text DR.
7 Provider Credential Text DO
8 Provider First Line Business Practice Location Address 890 VIEWMONT DR
9 Provider Business Practice Location Address City Name DICKSON CITY
10 Provider Business Practice Location Address State Name PA
11 Provider Business Practice Location Address Postal Code 185191699
12 Provider Business Practice Location Address Country Code If outside U S US
13 Provider Business Practice Location Address Telephone Number 5702074360
14 Provider Business Practice Location Address Fax Number 5703831940
15 Provider Enumeration Date 3/9/2006
16 Last Update Date 8/14/2013
17 Provider Gender Code F
18 Healthcare Provider Taxonomy Code 1 208000000X
19 Provider License Number 1 OS009616L
20 Provider License Number State Code 1 PA
21 Healthcare Provider Primary Taxonomy Switch 1 Y
22 Other Provider Identifier 1 001677040
23 Other Provider Identifier Type Code 1 05
24 Other Provider Identifier State 1 PA
25 Other Provider Identifier 2 G62024
26 Other Provider Identifier Type Code 2 02
27 Other Provider Identifier State 2 PA
28 Is Sole Proprietor N

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This page was last updated on: 7/15/2014
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.