Provider Demographics
NPI:1528407145
Name:STIVALA, SURUJDAI JASMINE (MS, ED)
Entity Type:Individual
Prefix:MRS
First Name:SURUJDAI
Middle Name:JASMINE
Last Name:STIVALA
Suffix:
Gender:F
Credentials:MS, ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5412 SYLVAN AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-2611
Mailing Address - Country:US
Mailing Address - Phone:646-522-5738
Mailing Address - Fax:
Practice Address - Street 1:5412 SYLVAN AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10471-2611
Practice Address - Country:US
Practice Address - Phone:646-522-5738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-17
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY258684171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator