Active NPI
Suchitra Razdan
- Speech-Language Pathologist
- Tyler, TX
National Provider Identifier
1689072811
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 17678
- Practice address
- 930 S Baxter Ave
Tyler, TX 75701-2209 - Phone
- (903) 597-2068
- NPI assigned
- Dec 22, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 17678 | TX | Primary |
Addresses
Primary practice location
930 S Baxter Ave
Tyler, TX 75701-2209
Mailing address
930 S Baxter Ave
Tyler, TX 75701-2209
Phone (903) 597-2068
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 001025984 | Medicaid | TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17678 | TX | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1419206400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1419206400000",
"number": "1689072811",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "930 S BAXTER AVE",
"city": "TYLER",
"state": "TX",
"postal_code": "757012209",
"telephone_number": "903-597-2068"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "930 S BAXTER AVE",
"city": "TYLER",
"state": "TX",
"postal_code": "757012209",
"telephone_number": "903-597-2068"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RAZDAN",
"first_name": "SUCHITRA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-12-22",
"last_updated": "2014-12-22",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "TX",
"license": "17678",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "001025984",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tyler, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.