Provider Demographics
NPI:1982832705
Name:SZUDLO, LACHAWNDA DANIELLE I (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:LACHAWNDA
Middle Name:DANIELLE
Last Name:SZUDLO
Suffix:I
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12073 TECH RD STE B
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-7874
Mailing Address - Country:US
Mailing Address - Phone:330-554-6350
Mailing Address - Fax:
Practice Address - Street 1:1595 ATHENA DR
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-4689
Practice Address - Country:US
Practice Address - Phone:330-554-6350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-01
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.128419-IV164W00000X
VA0024186851363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No164W00000XNursing Service ProvidersLicensed Practical Nurse