Individual
LESLIE JAY SUGA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD HSPP
Contact information
Practice address
6515 E 82ND ST, SUITE 210, INDIANAPOLIS, IN 46250-1576
(317) 559-0990
(317) 653-6405
Mailing address
8539 TIDEWATER DR, INDIANAPOLIS, IN 46236-8917
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
20040349A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100376990A
—
IN
01
—
680013641
MEDICARE RAILROAD
IN
Enumeration date
08/18/2005
Last updated
10/25/2014
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