Provider Demographics
NPI:1477258093
Name:SUDANI, ASHABEN
Entity Type:Individual
Prefix:
First Name:ASHABEN
Middle Name:
Last Name:SUDANI
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:PO BOX 328
Mailing Address - Street 2:
Mailing Address - City:ALVISO
Mailing Address - State:CA
Mailing Address - Zip Code:95002-0328
Mailing Address - Country:US
Mailing Address - Phone:408-307-5210
Mailing Address - Fax:
Practice Address - Street 1:315 S ABBOTT AVE
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-5254
Practice Address - Country:US
Practice Address - Phone:408-790-2900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT294988225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty