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NPI Code Detail

MEDICARE: DR. MICHAEL EVAN SUDE PH.D. MFT

MEDICARE: DR. MICHAEL EVAN SUDE PH.D. MFT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family TherapistP54396NY
2106H00000XMarriage & Family Therapist718NY

General Provider Information

NPI Number : 1942418157
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICHAEL EVAN SUDE PH.D. MFT
Provider Business Mailing Address
First Line : 4101 E GENESEE ST
Second Line :
City : SYRACUSE
State : NY
Zip : 13214-2136
Country : US
Telephone Number : 315-445-0820
Fax Number : 315-445-0859
Provider Business Practice Location Address
First Line : 4101 E GENESEE ST
Second Line :
City : SYRACUSE
State : NY
Zip : 13214-2136
Country : US
Telephone Number : 315-445-0820
Fax Number : 315-445-0859
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/19/2007
Last Update Date : 06/10/2009

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