Provider Demographics
NPI:1891298287
Name:PONDICHERRY CHANDERSEN, SUMA SUNDERSEN (PT)
Entity Type:Individual
Prefix:DR
First Name:SUMA
Middle Name:SUNDERSEN
Last Name:PONDICHERRY CHANDERSEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4340 AVONDALE LN
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-2091
Mailing Address - Country:US
Mailing Address - Phone:470-695-5455
Mailing Address - Fax:
Practice Address - Street 1:16 GARDENIA LN
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-2009
Practice Address - Country:US
Practice Address - Phone:917-386-3434
Practice Address - Fax:866-447-4544
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-13
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042468225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist