Alicja Erazo Sundblade, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

5006468 Issued in NC

Practice address

1918 Randolph Rd
Suite 350
Charlotte, NC 28207-1100

Phone

(704) 384-1750

NPI assigned

Sep 11, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: alicja.sundblade.1@27575.direct.athenahealth.com
• Direct secure messaging: asundblade79435@direct.novanthealth.org

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.

• Forsyth Medical Group, LLC

  dba Privia Medical Group - North Carolina

  • Obstetrics & Gynecology Physician
  • Hendersonville, NC
  • NPI 1750081378
  Medicare reassignment NPD
• Forsyth Medical Group LLC

  dba Queen City Ear Nose and Throat

  • Otolaryngology Physician
  • Monroe, NC
  • NPI 1710866405
  NPD
• Forsyth Memorial Hospital Inc

  dba Novant Health Cardiology

  • Cardiovascular Disease Physician
  • Winston Salem, NC
  • NPI 1114200771
  NPD (past)

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

{
    "created_epoch": "1378857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603843200000",
    "number": "1184059958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60447",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282600447",
            "telephone_number": "704-384-7840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1918 RANDOLPH RD",
            "address_2": "SUITE 350",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282071100",
            "telephone_number": "704-384-1750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUNDBLADE",
        "first_name": "ALICJA",
        "middle_name": "ERAZO",
        "name_prefix": "Mrs.",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-09-11",
        "last_updated": "2020-10-28",
        "certification_date": "2020-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NC",
            "license": "229325",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "5006468",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "asundblade79435@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "1918 Randolph Rd",
            "address_2": "Suite 350",
            "city": "Charlotte",
            "state": "NC",
            "country_code": "US",
            "postal_code": "282071100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Vishalakshi Kalyana Sundaram, MD
• Naresh Sundaresan, MD
• Raghavanand Sundaresh
• Sunday Money, LLC (Home Instead)
• Thomas C Sundberg, M.D.
• Brent Anthony Sunderland, MD
• Theresa Kay Sunderland, MD
• Sunflower Speech & Myo Therapy, PLLC
• Sunflower Therapeutic Solutions, PLLC
• Maxim Sungurov

• Family Nurse Practitioner in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Family Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.