Healthcare Provider Details

I. General information

NPI: 1528971942
Provider Name (Legal Business Name): IPEK SU TALU MSED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

469 HOWE AVE
SHELTON CT
06484-3155
US

IV. Provider business mailing address

208 W 23RD ST APT 1015
NEW YORK NY
10011-2316
US

V. Phone/Fax

Practice location:
  • Phone: 203-231-8804
  • Fax:
Mailing address:
  • Phone: 858-337-6803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10276
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: