Provider Demographics
NPI:1851863351
Name:SUDDS, DIAMOND (CD, CBE)
Entity type:Individual
Prefix:
First Name:DIAMOND
Middle Name:
Last Name:SUDDS
Suffix:
Gender:F
Credentials:CD, CBE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:951 S SPRAGUE AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405
Mailing Address - Country:US
Mailing Address - Phone:253-652-8924
Mailing Address - Fax:
Practice Address - Street 1:951 S SPRAGUE AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-3011
Practice Address - Country:US
Practice Address - Phone:253-652-8924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-20
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH105458616799Medicaid