Provider Demographics
NPI:1013553148
Name:SUDA, ASHLEY NOEL
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:NOEL
Last Name:SUDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8212 PARKVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-1419
Mailing Address - Country:US
Mailing Address - Phone:219-791-3634
Mailing Address - Fax:
Practice Address - Street 1:8380 VIRGINIA ST
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-6231
Practice Address - Country:US
Practice Address - Phone:219-769-9009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-25
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31007013A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist