Sandra Lynn Mundy Gooden, SA C SURGICAL ASSIST

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

078114 Issued in OH

Practice address

12300 McCracken Rd
Marymount Hospital
Garfield HTS, OH 44125-2914

Phone

(216) 587-8200

Fax

(216) 587-6715

NPI assigned

Jul 21, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Miss Sandra Lynn Mundy Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1216598400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1216598400000",
    "number": "1649435504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12300 MCCRACKEN RD",
            "address_2": "MARYMOUNT HOSPITAL",
            "city": "GARFIELD HTS",
            "state": "OH",
            "postal_code": "441252914",
            "telephone_number": "216-587-8200",
            "fax_number": "216-587-6715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12300 MCCRACKEN RD",
            "address_2": "MARYMOUNT HOSPITAL",
            "city": "GARFIELD HTS",
            "state": "OH",
            "postal_code": "441252914",
            "telephone_number": "216-587-8200",
            "fax_number": "216-587-6715"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUNDY GOODEN",
        "first_name": "SANDRA",
        "middle_name": "LYNN",
        "name_prefix": "Mrs.",
        "credential": "SA C SURGICAL ASSIST",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-07-21",
        "last_updated": "2008-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "OH",
            "license": "078114",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SANDRA",
            "last_name": "MUNDY",
            "middle_name": "LYNN",
            "prefix": "MISS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Surgical Physician Assistant in Garfield HTS, OH
• Providers in Garfield HTS, OH by specialty
• Surgical Physician Assistant in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2008; 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.