Provider Demographics
NPI:1689062556
Name:THAPA RAUT, SUSHILA
Entity Type:Individual
Prefix:
First Name:SUSHILA
Middle Name:
Last Name:THAPA RAUT
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 1:1655 PUTNAM AVE APT 2L
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-3411
Mailing Address - Country:US
Mailing Address - Phone:347-446-5153
Mailing Address - Fax:
Practice Address - Street 1:1655 PUTNAM AVE APT 2L
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-3411
Practice Address - Country:US
Practice Address - Phone:347-446-5153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-31
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY320206164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse