Healthcare Provider Details

I. General information

NPI: 1093658262
Provider Name (Legal Business Name): SHARDA SUZANNE MOUGEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 E BROAD ST
COLUMBUS OH
43215-4004
US

IV. Provider business mailing address

875 BURR AVE UNIT 407
COLUMBUS OH
43212-1198
US

V. Phone/Fax

Practice location:
  • Phone: 614-885-5020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberM.2600419
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: