Provider Demographics
NPI:1104823863
Name:TRAVIS, SUSAN MARIE (CPNP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARIE
Last Name:TRAVIS
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Gender:F
Credentials:CPNP
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Mailing Address - Street 1:50 DAYTON LANE, SUITE 202
Mailing Address - Street 2:THE WESTCHESTER MEDICAL PRACTICE PC
Mailing Address - City:PEEKSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10566
Mailing Address - Country:US
Mailing Address - Phone:914-739-0087
Mailing Address - Fax:914-737-1714
Practice Address - Street 1:35 S RIVERSIDE AVE
Practice Address - Street 2:THE WESTCHESTER MEDICAL PRACTICE PC
Practice Address - City:CROTON ON HUDSON
Practice Address - State:NY
Practice Address - Zip Code:10520-2653
Practice Address - Country:US
Practice Address - Phone:914-271-2424
Practice Address - Fax:914-271-2172
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2013-08-01
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Provider Licenses
StateLicense IDTaxonomies
NYF381651-1363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics