Healthcare Provider Details

I. General information

NPI: 1518595289
Provider Name (Legal Business Name): SUSUANA ADJEI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 W 86TH ST
INDIANAPOLIS IN
46260-1902
US

IV. Provider business mailing address

4520 N MACARTHUR BLVD # 100
IRVING TX
75038-1235
US

V. Phone/Fax

Practice location:
  • Phone: 317-338-6399
  • Fax:
Mailing address:
  • Phone: 214-630-5256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberT2303
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: