Edanilka Medina Sustache, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

6832 Issued in PR

Practice address

Urb. Los Arboles 341 Granada Street
Rio Grande, PR 00745

Phone

(787) 602-0547

NPI assigned

Jul 23, 2024

Last updated

Jul 23, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1721692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721692800000",
    "number": "1215765193",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "URB. LOS ARBOLES 341 GRANADA STREET",
            "city": "RIO GRANDE",
            "state": "PR",
            "postal_code": "00745",
            "telephone_number": "787-602-0547"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "URB. LOS ARBOLES 341 GRANADA STREET",
            "city": "RIO GRANDE",
            "state": "PR",
            "postal_code": "00745",
            "telephone_number": "787-602-0547"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDINA SUSTACHE",
        "first_name": "EDANILKA",
        "name_prefix": "Ms.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-07-23",
        "last_updated": "2024-07-23",
        "certification_date": "2024-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "PR",
            "license": "6832",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Silma L. Martinez, MD
• Evelyn Matta Fontanet, M.D.
• Yanializ Matta, MSW
• Medical Education Group PSC
• Medicos Aliados del Noreste
• David J Medina, MA
• Frankie T Medina
• Yadymariz Medina, SLP
• Meditech Clinical Laboratories Inc (Laboratorio Clinico Meditech)
• Carlos Mejia, CONTRACTOR

• Clinical Psychologist in Rio Grande, PR
• Providers in Rio Grande, PR by specialty
• Clinical Psychologist in Puerto Rico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.