Provider Demographics
NPI:1215352406
Name:SUDLOW, ROBIN
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:SUDLOW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 EDGEWATER RD
Mailing Address - Street 2:
Mailing Address - City:AGAWAM
Mailing Address - State:MA
Mailing Address - Zip Code:01001-2310
Mailing Address - Country:US
Mailing Address - Phone:413-285-6153
Mailing Address - Fax:
Practice Address - Street 1:90 EDGEWATER RD
Practice Address - Street 2:
Practice Address - City:AGAWAM
Practice Address - State:MA
Practice Address - Zip Code:01001-2310
Practice Address - Country:US
Practice Address - Phone:413-285-6153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-25
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency