Provider Demographics
NPI:1376529560
Name:ESHUN, SUSSIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSSIE
Middle Name:
Last Name:ESHUN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 957
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-4257
Mailing Address - Country:US
Mailing Address - Phone:570-424-6734
Mailing Address - Fax:
Practice Address - Street 1:223 WASHINGTON ST
Practice Address - Street 2:IST FLOOR OFFICE
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-2862
Practice Address - Country:US
Practice Address - Phone:570-424-6734
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS015651103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAES1762927OtherHIGHMARK BLUESHIELD
PA095616Medicare ID - Type Unspecified