Healthcare Provider Details

I. General information

NPI: 1386548162
Provider Name (Legal Business Name): SALUMA SUFI
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1036 SHARON DR
JEFFERSONVILLE IN
47130-4522
US

IV. Provider business mailing address

8218 SAINT ANTHONYS CHURCH RD
LOUISVILLE KY
40214-4520
US

V. Phone/Fax

Practice location:
  • Phone: 812-280-6606
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4064071
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: