Provider Demographics
NPI:1376073445
Name:SULTUSKA, MALINDI
Entity Type:Individual
Prefix:
First Name:MALINDI
Middle Name:
Last Name:SULTUSKA
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 1:858 BROOKWOOD DR APT 102
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-4916
Mailing Address - Country:US
Mailing Address - Phone:405-795-9835
Mailing Address - Fax:
Practice Address - Street 1:858 BROOKWOOD DR APT 102
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-4916
Practice Address - Country:US
Practice Address - Phone:405-795-9835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator