Provider Demographics
NPI:1033666763
Name:SUE-HO, LEAH (LPN)
Entity Type:Individual
Prefix:MS
First Name:LEAH
Middle Name:
Last Name:SUE-HO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 VINYARD WAY
Mailing Address - Street 2:
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-2440
Mailing Address - Country:US
Mailing Address - Phone:347-351-0984
Mailing Address - Fax:
Practice Address - Street 1:12 VINYARD WAY
Practice Address - Street 2:
Practice Address - City:CORAM
Practice Address - State:NY
Practice Address - Zip Code:11727-2440
Practice Address - Country:US
Practice Address - Phone:347-351-0984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-11
Last Update Date:2016-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY325952164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse