Individual provider Active NPI

Kaiya Mare' Sundeen

  • Physician Assistant
  • Portland, ME
National Provider Identifier
1659110906
Registry record updated Jul 31, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA01951 Issued in RI
Practice address
716 Stevens Ave
Portland, ME 04103-2693
Phone
(715) 220-6250
NPI assigned
May 24, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Physician Assistant 363A00000X PA01951 RI Primary

Addresses

Primary practice location

716 Stevens Ave
Portland, ME 04103-2693

Mailing address

716 Stevens Ave
Portland, ME 04103-2693

Other practice location 1

450 Clinton St
Woonsocket, RI 02895-3207
Phone (401) 767-4100

Other practice location 2

360 Kingstown Rd Unit 101
Narragansett, RI 02882-3258
Phone (401) 767-4100

Other practice location 3

1 River St
Wakefield, RI 02879-3214
Phone (401) 767-4100

Other practice location 4

186 Providence St
West Warwick, RI 02893-2508
Phone (401) 767-4100

Medicare participation

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

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2026
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1885 FM 2673 Unit
Suite 146
Canyon Lake, TX 78133-4765

25 John a Cummings Way
Suite 203
Woonsocket, RI 02895-3224

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

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

{
    "created_epoch": "1716508800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785456000000",
    "number": "1659110906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "716 STEVENS AVE",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041032693"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "716 STEVENS AVE",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041032693",
            "telephone_number": "715-220-6250"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "450 Clinton St",
            "address_purpose": "LOCATION",
            "city": "Woonsocket",
            "state": "RI",
            "postal_code": "028953207",
            "country_code": "US",
            "telephone_number": "401-767-4100",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "360 Kingstown Rd Unit 101",
            "address_purpose": "LOCATION",
            "city": "Narragansett",
            "state": "RI",
            "postal_code": "028823258",
            "country_code": "US",
            "telephone_number": "401-767-4100",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1 River St",
            "address_purpose": "LOCATION",
            "city": "Wakefield",
            "state": "RI",
            "postal_code": "028793214",
            "country_code": "US",
            "telephone_number": "401-767-4100",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "186 Providence St",
            "address_purpose": "LOCATION",
            "city": "West Warwick",
            "state": "RI",
            "postal_code": "028932508",
            "country_code": "US",
            "telephone_number": "401-767-4100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SUNDEEN",
        "first_name": "KAIYA",
        "middle_name": "MARE'",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-05-24",
        "last_updated": "2026-07-31",
        "certification_date": "2026-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "RI",
            "license": "PA01951",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, ME

Sources for this page

Verify at the official NPI Registry.