Individual
SUDEEP GC
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
940 BELMONT ST BLDG 2, BROCKTON, MA 02301-5596
(774) 826-2079
Mailing address
133 TAYLOR ST, MALDEN, MA 02148-8021
(205) 413-0878
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
2278501
MA
Other
Enumeration date
03/26/2025
Last updated
03/26/2025
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