Provider Demographics
NPI:1841208287
Name:SUFFREDINI, KATHLEEN DEERY (MA, PT)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:DEERY
Last Name:SUFFREDINI
Suffix:
Gender:F
Credentials:MA, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 RICE CT
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-1149
Mailing Address - Country:US
Mailing Address - Phone:301-340-9269
Mailing Address - Fax:
Practice Address - Street 1:932 HUNGERFORD DR
Practice Address - Street 2:STE 35A
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-1753
Practice Address - Country:US
Practice Address - Phone:301-340-6413
Practice Address - Fax:301-340-0669
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2017-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15701174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD983700100Medicaid
MD806260Medicare ID - Type UnspecifiedPROVIDER NUMBER