Provider Demographics
NPI:1063051951
Name:SUSAHEALTH LLC
Entity type:Organization
Organization Name:SUSAHEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:
Authorized Official - First Name:SHAHNAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-652-6248
Mailing Address - Street 1:5406 CONNECTICUT AVE NW APT 705
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20015-2855
Mailing Address - Country:US
Mailing Address - Phone:347-652-6248
Mailing Address - Fax:
Practice Address - Street 1:1666 CONNECTICUT AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-1039
Practice Address - Country:US
Practice Address - Phone:202-902-9004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-26
Last Update Date:2020-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty