Provider Demographics
NPI:1760802037
Name:SUGA NEUROPSYCHOLOGICAL SERVICES, LLC
Entity Type:Organization
Organization Name:SUGA NEUROPSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:SUGA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:317-823-9155
Mailing Address - Street 1:8539 TIDEWATER DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46236-8917
Mailing Address - Country:US
Mailing Address - Phone:317-823-9155
Mailing Address - Fax:
Practice Address - Street 1:6296 RUCKER RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-4888
Practice Address - Country:US
Practice Address - Phone:317-823-9155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-24
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ININ1975Medicare PIN