Provider Demographics
NPI:1164408159
Name:GRAVIUS, SUZANN PATRICIA (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:SUZANN
Middle Name:PATRICIA
Last Name:GRAVIUS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:SUZANN
Other - Middle Name:P
Other - Last Name:MURPHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:7 HENRY ST
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:NY
Mailing Address - Zip Code:10962-2306
Mailing Address - Country:US
Mailing Address - Phone:845-613-7957
Mailing Address - Fax:
Practice Address - Street 1:800 WESTCHESTER AVE # 511
Practice Address - Street 2:
Practice Address - City:RYE BROOK
Practice Address - State:NY
Practice Address - Zip Code:10573-1354
Practice Address - Country:US
Practice Address - Phone:914-428-5354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-21
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY477871-1367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR0C321Medicare ID - Type Unspecified
NYP90461Medicare UPIN