Provider Demographics
NPI:1689613606
Name:HENRY, SUNDAY D (MD)
Entity type:Individual
Prefix:
First Name:SUNDAY
Middle Name:D
Last Name:HENRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 642302
Mailing Address - Street 2:
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99164-2302
Mailing Address - Country:US
Mailing Address - Phone:509-335-3575
Mailing Address - Fax:509-335-6223
Practice Address - Street 1:1125 SE WASHINGTON
Practice Address - Street 2:PO BOX 642302
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99164-2302
Practice Address - Country:US
Practice Address - Phone:509-335-3575
Practice Address - Fax:509-335-6223
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60279667207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806357600Medicaid
ID806357600Medicaid
I40837Medicare UPIN
ID1131598Medicare PIN