Provider Demographics
NPI:1083080782
Name:ZANNONI, SUSAN (PMHNP-DNP)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:ZANNONI
Suffix:
Gender:F
Credentials:PMHNP-DNP
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:MAZURCHUK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP
Mailing Address - Street 1:315 ALBERTA DRIVE
Mailing Address - Street 2:SUITE 211
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226
Mailing Address - Country:US
Mailing Address - Phone:716-837-6705
Mailing Address - Fax:716-837-6759
Practice Address - Street 1:315 ALBERTA DRIVE
Practice Address - Street 2:SUITE 211
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226
Practice Address - Country:US
Practice Address - Phone:716-837-6705
Practice Address - Fax:716-837-6759
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY401892363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health