MEDICARE: NATASHA SUSSEWELL

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
1	106S00000X	Behavior Technician
2	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1982354270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATASHA SUSSEWELL

Provider Business Mailing Address
First Line	:	6043 N HIL MAR CIR
Second Line	:
City	:	DISTRICT HEIGHTS
State	:	MD
Zip	:	20747-2962
Country	:	US
Telephone Number	:	202-427-9166
Fax Number	:

Provider Business Practice Location Address
First Line	:	6043 N HIL MAR CIR
Second Line	:
City	:	DISTRICT HEIGHTS
State	:	MD
Zip	:	20747-2962
Country	:	US
Telephone Number	:	202-427-9166
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2022
Last Update Date	:	02/23/2025

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