Provider Demographics
NPI:1851048029
Name:SUDDUTH, NIAH DIONNE
Entity type:Individual
Prefix:
First Name:NIAH
Middle Name:DIONNE
Last Name:SUDDUTH
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 1:11811 OAKSHIELD LN
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-1605
Mailing Address - Country:US
Mailing Address - Phone:773-930-8587
Mailing Address - Fax:
Practice Address - Street 1:11811 OAKSHIELD LN
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-1605
Practice Address - Country:US
Practice Address - Phone:773-930-8587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-07
Last Update Date:2023-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator