Provider Demographics
NPI:1295525863
Name:SUSSHOLZ, RACHELLE
Entity type:Individual
Prefix:MRS
First Name:RACHELLE
Middle Name:
Last Name:SUSSHOLZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:RACHELLE
Other - Middle Name:
Other - Last Name:BLATT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:22 EDISON CT APT E
Mailing Address - Street 2:
Mailing Address - City:MONSEY
Mailing Address - State:NY
Mailing Address - Zip Code:10952-1921
Mailing Address - Country:US
Mailing Address - Phone:845-709-1025
Mailing Address - Fax:
Practice Address - Street 1:386 ROUTE 59 STE 102
Practice Address - Street 2:
Practice Address - City:AIRMONT
Practice Address - State:NY
Practice Address - Zip Code:10952-3428
Practice Address - Country:US
Practice Address - Phone:845-368-7927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No252Y00000XAgenciesEarly Intervention Provider Agency