Individual
SCOTT DESI SUDAISAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
22350 SW PINE ST, SHERWOOD, OR 97140-9075
(503) 349-5828
Mailing address
PO BOX 1238, NEWBERG, OR 97132-8238
(503) 349-5828
Taxonomy
Speciality
Code
Description
License number
State
405300000X
Prevention Professional
Primary
083697
OR
Other
Enumeration date
06/15/2023
Last updated
06/15/2023
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