Provider Demographics
NPI:1063804896
Name:CHANDMAL, SUSHEELA KUMARI (RN)
Entity type:Individual
Prefix:MRS
First Name:SUSHEELA
Middle Name:KUMARI
Last Name:CHANDMAL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 PURCELL DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75040
Mailing Address - Country:US
Mailing Address - Phone:972-205-1060
Mailing Address - Fax:
Practice Address - Street 1:2300, MARIE CURIE BLVD
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040
Practice Address - Country:US
Practice Address - Phone:972-487-5541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-03
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX842694163W00000X
CT076762163W00000X
ZZ975935067163W00000X
ZZ8775163W00000X
ZZ7330163WM0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn