Individual
LESLIE JAY SUGA
Active
Individual
LESLIE JAY SUGA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD HSPP
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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