MEDICARE: DR. MEGHANA SUCHAK PHD

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	103T00000X	Psychologist	174664	KY
2	103TC0700X	Clinical Psychologist	174664	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1003458605	OTHER	KY	TYPE 11 NPI

General Provider Information

NPI Number	:	1346633674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MEGHANA SUCHAK PHD

Provider Business Mailing Address
First Line	:	4010 DUPONT CIR
Second Line	:	STE 574
City	:	LOUISVILLE
State	:	KY
Zip	:	40207-4843
Country	:	US
Telephone Number	:	502-912-1498
Fax Number	:

Provider Business Practice Location Address
First Line	:	2325 LIME KILN LN STE A
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40222-3418
Country	:	US
Telephone Number	:	502-912-1498
Fax Number	:

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

Provider Enumeration Date	:	03/11/2015
Last Update Date	:	08/05/2021

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