Scott Desi Sudaisar

Primary specialty

Prevention ProfessionalTaxonomy code 405300000X

License

083697 Issued in OR

Practice address

22350 SW Pine St
Sherwood, OR 97140-9075

Phone

(503) 349-5828

NPI assigned

Jun 15, 2023

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Sudaisar Polygraph & Forensic Assessments, LLC

  • Prevention Professional
  • Sherwood, OR
  • NPI 1790460038

  Single Specialty

  NPD Authorized official

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

{
    "created_epoch": "1686787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686787200000",
    "number": "1649955980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1238",
            "city": "NEWBERG",
            "state": "OR",
            "postal_code": "971328238",
            "telephone_number": "503-349-5828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22350 SW PINE ST",
            "city": "SHERWOOD",
            "state": "OR",
            "postal_code": "971409075",
            "telephone_number": "503-349-5828"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "62910 O B Riley Rd Ste 301-B",
            "address_purpose": "LOCATION",
            "city": "Bend",
            "state": "OR",
            "postal_code": "977038697",
            "country_code": "US",
            "telephone_number": "503-349-5828",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SUDAISAR",
        "first_name": "SCOTT",
        "middle_name": "DESI",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-06-15",
        "last_updated": "2023-06-15",
        "certification_date": "2023-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "405300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Prevention Professional",
            "state": "OR",
            "license": "083697",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Patricia Sturgeon, LCSW
• Darcy Ann Sturges
• Elena Styles, DO
• Sujitha Subramaniam
• Sudaisar Polygraph & Forensic Assessments, LLC
• Piper H Sullivan, PA-C
• Margo Anderson Svendsen, M.S. CCC-SLP
• Jennifer Swartz
• Toni Swartz, NCMA, CBD, CLC
• Holly Sweeney

• Prevention Professional in Sherwood, OR
• Providers in Sherwood, OR by specialty
• Prevention Professional in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2023; 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.