Provider Demographics
NPI:1275282105
Name:KALDAN, SUSHMITA
Entity Type:Individual
Prefix:
First Name:SUSHMITA
Middle Name:
Last Name:KALDAN
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 1:290 MLK JR DR SE UNIT 2208
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-2541
Mailing Address - Country:US
Mailing Address - Phone:404-642-9095
Mailing Address - Fax:
Practice Address - Street 1:290 MLK JR DR SE UNIT 2208
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-2541
Practice Address - Country:US
Practice Address - Phone:404-642-9095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-18
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN281484363LA2100X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse