Provider Demographics
NPI:1760236178
Name:GHALE, SUSHMA
Entity Type:Individual
Prefix:
First Name:SUSHMA
Middle Name:
Last Name:GHALE
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 1:5863 41ST DR
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-4834
Mailing Address - Country:US
Mailing Address - Phone:929-801-0273
Mailing Address - Fax:
Practice Address - Street 1:5863 41ST DR
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-4834
Practice Address - Country:US
Practice Address - Phone:929-801-0273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-12
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency