MEDICARE: MILENA JERENE SUDAK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1164764304
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MILENA JERENE SUDAK

Provider Business Mailing Address
First Line	:	1405 SAN CARLOS RD SW APT 7
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87104-1060
Country	:	US
Telephone Number	:	720-495-2346
Fax Number	:

Provider Business Practice Location Address
First Line	:	1405 SAN CARLOS RD SW APT 7
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87104-1060
Country	:	US
Telephone Number	:	720-495-2346
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/26/2013
Last Update Date	:	03/14/2023

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Directions to “ MILENA JERENE SUDAK ” Practice Location

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