Provider Demographics
NPI:1972074573
Name:SUGLAM, THALIA (CERTIFIED HAIRLOSS)
Entity Type:Individual
Prefix:
First Name:THALIA
Middle Name:
Last Name:SUGLAM
Suffix:
Gender:F
Credentials:CERTIFIED HAIRLOSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12517 9TH AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:COLLEGE POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11356-1219
Mailing Address - Country:US
Mailing Address - Phone:516-373-5991
Mailing Address - Fax:
Practice Address - Street 1:12517 9TH AVE
Practice Address - Street 2:
Practice Address - City:COLLEGE POINT
Practice Address - State:NY
Practice Address - Zip Code:11356-1219
Practice Address - Country:US
Practice Address - Phone:516-373-5991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-09
Last Update Date:2018-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management