Healthcare Provider Details

I. General information

NPI: 1275469223
Provider Name (Legal Business Name): AYESHA CHATTERJI SUJAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 MIDDLEFIELD RD
MENLO PARK CA
94025-3500
US

IV. Provider business mailing address

3145 PORTER DR
PALO ALTO CA
94304-1224
US

V. Phone/Fax

Practice location:
  • Phone: 650-497-8977
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY35249
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: