Provider Demographics
NPI:1104638790
Name:GUNDERMAN, SCOTT CHRISTOPHER (PROVIDER)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:CHRISTOPHER
Last Name:GUNDERMAN
Suffix:
Gender:M
Credentials:PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1621 TUXEDO AVE
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44134-1737
Mailing Address - Country:US
Mailing Address - Phone:216-450-7171
Mailing Address - Fax:
Practice Address - Street 1:1621 TUXEDO AVE
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44134-1737
Practice Address - Country:US
Practice Address - Phone:216-450-7171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-22
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
No101200000XBehavioral Health & Social Service ProvidersDrama Therapist