Provider Demographics
NPI:1164527891
Name:SHEFFIELD, SUSAN MARTHA (MS, PNP-BC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARTHA
Last Name:SHEFFIELD
Suffix:
Gender:F
Credentials:MS, PNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 E ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-2306
Mailing Address - Country:US
Mailing Address - Phone:315-464-6340
Mailing Address - Fax:315-464-6329
Practice Address - Street 1:750 E ADAMS ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-2306
Practice Address - Country:US
Practice Address - Phone:315-464-6340
Practice Address - Fax:315-464-6329
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY244590163WP0200X
NY380967363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WP0200XNursing Service ProvidersRegistered NursePediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02118312Medicaid
NYBB9204Medicare PIN