Healthcare Provider Details

I. General information

NPI: 1356927784
Provider Name (Legal Business Name): SHUCHUN SABRINA SU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2021
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 BRUNSWICK WOODS DR
EAST BRUNSWICK NJ
08816-5601
US

IV. Provider business mailing address

16 STOOTHOFF DR
NEW HYDE PARK NY
11040-3621
US

V. Phone/Fax

Practice location:
  • Phone: 646-361-4468
  • Fax: 732-889-7520
Mailing address:
  • Phone: 646-361-4468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: