Individual
SUHAILA DEVIDASI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
257 SW MADISON AVE, CORVALLIS, OR 97333-4757
(541) 752-7220
Mailing address
257 SW MADISON AVE, CORVALLIS, OR 97333-4757
(541) 752-7220
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
12/19/2019
Last updated
12/19/2019
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