Provider Demographics
NPI:1356927784
Name:SU, SHUCHUN SABRINA
Entity type:Individual
Prefix:
First Name:SHUCHUN
Middle Name:SABRINA
Last Name:SU
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 1:16 STOOTHOFF DR
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-3621
Mailing Address - Country:US
Mailing Address - Phone:646-361-4468
Mailing Address - Fax:
Practice Address - Street 1:54 BRUNSWICK WOODS DR
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-5601
Practice Address - Country:US
Practice Address - Phone:646-361-4468
Practice Address - Fax:732-889-7520
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-24
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist
No374U00000XNursing Service Related ProvidersHome Health Aide