Provider Demographics
NPI:1083923098
Name:ALLY, SUZANNE T (RN)
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:T
Last Name:ALLY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8602 208TH ST
Mailing Address - Street 2:APT 3A
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11427-1677
Mailing Address - Country:US
Mailing Address - Phone:718-464-0621
Mailing Address - Fax:
Practice Address - Street 1:8602 208TH ST
Practice Address - Street 2:APT 3A
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11427-1677
Practice Address - Country:US
Practice Address - Phone:718-464-0621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-26
Last Update Date:2010-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY377174163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health