Provider Demographics
NPI:1548664139
Name:MUSHTAQ, SUNDAS
Entity type:Individual
Prefix:
First Name:SUNDAS
Middle Name:
Last Name:MUSHTAQ
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 1:3985 STEVE REYNOLDS BLVD
Mailing Address - Street 2:BUILDING G
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-3035
Mailing Address - Country:US
Mailing Address - Phone:770-622-2532
Mailing Address - Fax:770-622-2534
Practice Address - Street 1:3905 JOHNS CREEK CT
Practice Address - Street 2:SUITE 250
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-1224
Practice Address - Country:US
Practice Address - Phone:770-888-5221
Practice Address - Fax:678-680-5929
Is Sole Proprietor?:No
Enumeration Date:2014-10-10
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT006056225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist