Healthcare Provider Details

I. General information

NPI: 1083060065
Provider Name (Legal Business Name): NATASHA SUSTACHE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2016
Last Update Date: 05/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3156A MILES AVE
BRONX NY
10465
US

IV. Provider business mailing address

3156A MILES AVE
BRONX NY
10465
US

V. Phone/Fax

Practice location:
  • Phone: 347-241-6383
  • Fax:
Mailing address:
  • Phone: 347-241-6383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number661637
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number340559
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: