Provider Demographics
NPI:1215451067
Name:SMITH, SUNDAY WRIGHT (RN, MSN, CNM)
Entity type:Individual
Prefix:
First Name:SUNDAY
Middle Name:WRIGHT
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN, MSN, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 S CANTON RD
Mailing Address - Street 2:
Mailing Address - City:POTSDAM
Mailing Address - State:NY
Mailing Address - Zip Code:13676-3162
Mailing Address - Country:US
Mailing Address - Phone:315-261-4370
Mailing Address - Fax:855-238-7127
Practice Address - Street 1:34 LAWRENCE AVENUE
Practice Address - Street 2:
Practice Address - City:POTSDAM
Practice Address - State:NY
Practice Address - Zip Code:13676
Practice Address - Country:US
Practice Address - Phone:315-261-4950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-02
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001809367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife