Provider Demographics
NPI:1962015743
Name:SUDLOW, SHANDEL A
Entity Type:Individual
Prefix:
First Name:SHANDEL
Middle Name:A
Last Name:SUDLOW
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 1:130 BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-2917
Mailing Address - Country:US
Mailing Address - Phone:347-776-6999
Mailing Address - Fax:
Practice Address - Street 1:130 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-2917
Practice Address - Country:US
Practice Address - Phone:347-776-6999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-31
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist