Provider Demographics
NPI:1447446430
Name:SUNDBERG, SHARLA (MD)
Entity type:Individual
Prefix:DR
First Name:SHARLA
Middle Name:
Last Name:SUNDBERG
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 1:315 75TH ST W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-3201
Mailing Address - Country:US
Mailing Address - Phone:941-761-1998
Mailing Address - Fax:877-501-8537
Practice Address - Street 1:315 75TH ST W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-3201
Practice Address - Country:US
Practice Address - Phone:941-761-1998
Practice Address - Fax:877-501-8537
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME120677208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHX882YMedicare PIN