Provider Demographics
NPI:1366253841
Name:UDIN-UNDERWOOD, SALMY
Entity type:Individual
Prefix:MS
First Name:SALMY
Middle Name:
Last Name:UDIN-UNDERWOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SALMY
Other - Middle Name:
Other - Last Name:DEAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2013 EASTCASTLE DR SE STE B
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49508-8873
Mailing Address - Country:US
Mailing Address - Phone:616-888-1120
Mailing Address - Fax:
Practice Address - Street 1:2013 EASTCASTLE DR SE STE B
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49508-8873
Practice Address - Country:US
Practice Address - Phone:616-888-1120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-15
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program