Individual provider Active NPI

Sundara Amber Lotus Fitz-Gerald, LMFT

  • Marriage & Family Therapist
  • Kailua Kona, HI
National Provider Identifier
1114272002
Registry record updated Jan 27, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
LMFT- 464 Issued in HI
Practice address
75-5744 Alii Dr Ste 237
Kailua Kona, HI 96740-1740
Phone
(808) 329-5800
NPI assigned
Jul 17, 2012
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 27, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X LMFT- 464 HI Primary

Addresses

Primary practice location

75-5744 Alii Dr Ste 237
Kailua Kona, HI 96740-1740

Mailing address

PO Box 2935
Kailua Kona, HI 96745-2935
Phone (808) 990-4605

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
LMFT- 464HIMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Dr Ashley & Associates LLC PastSince Aug 27, 2014 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1342483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1453852800000",
    "number": "1114272002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2935",
            "city": "KAILUA KONA",
            "state": "HI",
            "postal_code": "967452935",
            "telephone_number": "808-990-4605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75-5744 ALII DR STE 237",
            "city": "KAILUA KONA",
            "state": "HI",
            "postal_code": "967401740",
            "telephone_number": "808-329-5800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FITZ-GERALD",
        "first_name": "SUNDARA",
        "middle_name": "AMBER LOTUS",
        "name_prefix": "Mrs.",
        "credential": "LMFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-07-17",
        "last_updated": "2016-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "HI",
            "license": "LMFT- 464",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kailua Kona, HI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.