Healthcare Provider Details

I. General information

NPI: 1588355861
Provider Name (Legal Business Name): CHISATO SUGA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2023
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 NEPONSET ST
WORCESTER MA
01606-2714
US

IV. Provider business mailing address

5 NEPONSET ST ATTN:MEDICAL STAFF SERVICES
WORCESTER MA
01606-2714
US

V. Phone/Fax

Practice location:
  • Phone: 508-856-0732
  • Fax: 508-425-5126
Mailing address:
  • Phone: 508-852-0600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2372405
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: