Provider Demographics
NPI:1033312244
Name:DECRUZ, SUZZUNNE NICOLE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:SUZZUNNE
Middle Name:NICOLE
Last Name:DECRUZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:240 INDIAN RIVER ROAD
Mailing Address - Street 2:SUITE A5
Mailing Address - City:ORANGE
Mailing Address - State:CT
Mailing Address - Zip Code:06477
Mailing Address - Country:US
Mailing Address - Phone:203-799-1252
Mailing Address - Fax:203-799-3252
Practice Address - Street 1:240 INDIAN RIVER ROAD
Practice Address - Street 2:A5
Practice Address - City:ORANGE
Practice Address - State:CT
Practice Address - Zip Code:06477
Practice Address - Country:US
Practice Address - Phone:203-799-1252
Practice Address - Fax:203-799-3252
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001433363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical