Provider Demographics
NPI:1902793284
Name:FORTUNE, SUNDY (RCS)
Entity type:Individual
Prefix:
First Name:SUNDY
Middle Name:
Last Name:FORTUNE
Suffix:
Gender:M
Credentials:RCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 LOGMILL LN
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879-3263
Mailing Address - Country:US
Mailing Address - Phone:561-306-8803
Mailing Address - Fax:
Practice Address - Street 1:1717 LOGMILL LN
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-3263
Practice Address - Country:US
Practice Address - Phone:561-306-8803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-19
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD100652246X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246X00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist Cardiovascular