Healthcare Provider Details

I. General information

NPI: 1992474175
Provider Name (Legal Business Name): SUJANA CHOWDHURY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2021
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 JUAN TABO BLVD NE STE 121F
ALBUQUERQUE NM
87112-1869
US

IV. Provider business mailing address

2901 JUAN TABO BLVD NE STE 121F
ALBUQUERQUE NM
87112-1869
US

V. Phone/Fax

Practice location:
  • Phone: 505-225-1849
  • Fax:
Mailing address:
  • Phone: 505-225-1849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2024-0845
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: