Healthcare Provider Details

I. General information

NPI: 1982832705
Provider Name (Legal Business Name): LACHAWNDA DANIELLE SZUDLO I PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2009
Last Update Date: 04/27/2023
Certification Date: 04/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1595 ATHENA DR
KENT OH
44240-4689
US

IV. Provider business mailing address

12073 TECH RD STE B
SILVER SPRING MD
20904-7874
US

V. Phone/Fax

Practice location:
  • Phone: 330-554-6350
  • Fax:
Mailing address:
  • Phone: 330-554-6350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024186851
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN.128419-IV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: