Provider Demographics
NPI:1578143863
Name:SUNDERLAND, DANIEL KENNETH (DO)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:KENNETH
Last Name:SUNDERLAND
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 N MAIN ST STE 211
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-1929
Mailing Address - Country:US
Mailing Address - Phone:860-236-0331
Mailing Address - Fax:860-263-8697
Practice Address - Street 1:41 N MAIN ST STE 211
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-1929
Practice Address - Country:US
Practice Address - Phone:860-236-0331
Practice Address - Fax:860-263-8697
Is Sole Proprietor?:No
Enumeration Date:2021-04-10
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT77281207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine