Provider Demographics
NPI:1164874566
Name:TISE, SUHEILY
Entity Type:Individual
Prefix:MRS
First Name:SUHEILY
Middle Name:
Last Name:TISE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 CENTRAL PARK S
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-1428
Mailing Address - Country:US
Mailing Address - Phone:212-319-5535
Mailing Address - Fax:
Practice Address - Street 1:210 CENTRAL PARK S
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1428
Practice Address - Country:US
Practice Address - Phone:212-319-5535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY607189163WM0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn