Provider Demographics
NPI:1588104244
Name:SUBBA, GUDIYA
Entity type:Individual
Prefix:
First Name:GUDIYA
Middle Name:
Last Name:SUBBA
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 1:4139 68TH ST # 11377
Mailing Address - Street 2:APT#3
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-3833
Mailing Address - Country:US
Mailing Address - Phone:972-552-0010
Mailing Address - Fax:
Practice Address - Street 1:4139 68TH ST # 11377
Practice Address - Street 2:APT#3
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-3833
Practice Address - Country:US
Practice Address - Phone:972-552-0010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-28
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY715383-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse