Provider Demographics
NPI:1417205493
Name:SUDERS, JENNIFER TANYA (DO)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:TANYA
Last Name:SUDERS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:TANYA
Other - Last Name:SHEYMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:58 16TH ST STE 500
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-3660
Mailing Address - Country:US
Mailing Address - Phone:304-242-7751
Mailing Address - Fax:
Practice Address - Street 1:58 16TH ST STE 500
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-3660
Practice Address - Country:US
Practice Address - Phone:304-242-7751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3170207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology