NPI 1649955980

Scott Desi Sudaisar

Practitioner Prevention Professional Sherwood, OR

Practice location

Address: 22350 SW Pine St, Sherwood, OR 97140-9075
Phone: (503) 349-5828
Mailing address: PO Box 1238, Newberg, OR 97132-8238

Registered specialties

Prevention Professional Primary

Other Service Providers Taxonomy 405300000X Licence 083697 (OR)

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Registry record

NPI: 1649955980
Entity type: Individual
Sex (as registered): Male
NPI issued: 15 Jun 2023
Record last updated: 15 Jun 2023

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.