Individual
BRENT ANTHONY SUNDERLAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
612 MOCKSVILLE AVENUE, CHARLOTTE, NC 28144-2732
(704) 210-5061
(704) 210-5337
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 210-5061
(704) 210-5337
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
200201631
NC
2084P0804X
Child & Adolescent Psychiatry Physician
200201631
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
89133CA
—
NC
05
—
N01632
—
SC
Enumeration date
02/02/2006
Last updated
10/20/2014
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