Provider Demographics
NPI:1639568660
Name:CHANDER, SUSHMITHA (EAMP LAC)
Entity Type:Individual
Prefix:
First Name:SUSHMITHA
Middle Name:
Last Name:CHANDER
Suffix:
Gender:F
Credentials:EAMP LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2439 61ST AVE SE
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-2420
Mailing Address - Country:US
Mailing Address - Phone:702-408-4595
Mailing Address - Fax:
Practice Address - Street 1:2439 61ST AVE SE
Practice Address - Street 2:
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-2420
Practice Address - Country:US
Practice Address - Phone:702-408-4595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-14
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60527825171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist