Provider Demographics
NPI:1194464776
Name:SUKUNDA, SUZANA
Entity Type:Individual
Prefix:
First Name:SUZANA
Middle Name:
Last Name:SUKUNDA
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 1:924 SYMONDS PL
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-5622
Mailing Address - Country:US
Mailing Address - Phone:315-542-2068
Mailing Address - Fax:
Practice Address - Street 1:924 SYMONDS PL
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-5622
Practice Address - Country:US
Practice Address - Phone:315-542-2068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide