Provider Demographics
NPI:1558524603
Name:MANDA, SUSHMA (MD,)
Entity Type:Individual
Prefix:DR
First Name:SUSHMA
Middle Name:
Last Name:MANDA
Suffix:
Gender:F
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7131 ARLINGTON RD APT 253
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-2944
Mailing Address - Country:US
Mailing Address - Phone:315-313-0146
Mailing Address - Fax:
Practice Address - Street 1:7131 ARLINGTON RD APT 253
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-2944
Practice Address - Country:US
Practice Address - Phone:315-313-0146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2552142084N0400X
VA01012718372084N0400X
NJ25MA111672002084N0400X
IN01086268A2084N0400X
FLME1177302084N0400X
WI76059-202084N0400X
MDD00921832084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology