Provider Demographics
NPI:1306865696
Name:RENDEIRO, SUSANNE (FNP)
Entity Type:Individual
Prefix:
First Name:SUSANNE
Middle Name:
Last Name:RENDEIRO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-3698
Mailing Address - Country:US
Mailing Address - Phone:212-334-6029
Mailing Address - Fax:212-334-7957
Practice Address - Street 1:400 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-3698
Practice Address - Country:US
Practice Address - Phone:212-334-6029
Practice Address - Fax:212-334-7957
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF331714163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYS54123Medicare UPIN