Provider Demographics
NPI:1669784765
Name:WADHWA, SUSHMA (RDCS,RVT)
Entity type:Individual
Prefix:MRS
First Name:SUSHMA
Middle Name:
Last Name:WADHWA
Suffix:
Gender:F
Credentials:RDCS,RVT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 WOODSIDE DR
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:IL
Mailing Address - Zip Code:61032-6730
Mailing Address - Country:US
Mailing Address - Phone:815-235-9648
Mailing Address - Fax:815-232-8730
Practice Address - Street 1:1600 WOODSIDE DR
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:IL
Practice Address - Zip Code:61032-6730
Practice Address - Country:US
Practice Address - Phone:815-235-9648
Practice Address - Fax:815-232-8730
Is Sole Proprietor?:No
Enumeration Date:2010-07-07
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL105395246XS1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonography