Provider Demographics
NPI:1306729959
Name:SUNDI, KIMBERLY ELAINE
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:ELAINE
Last Name:SUNDI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17369 PREST ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235-3731
Mailing Address - Country:US
Mailing Address - Phone:313-303-6807
Mailing Address - Fax:
Practice Address - Street 1:14247 WOODMONT AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48227-1325
Practice Address - Country:US
Practice Address - Phone:313-516-7357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-30
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIS530469201675374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide