Provider Demographics
NPI:1326641242
Name:FRITH-HEADLEY, SUSANE (DNP, FNP, AG-ACNP)
Entity Type:Individual
Prefix:DR
First Name:SUSANE
Middle Name:
Last Name:FRITH-HEADLEY
Suffix:
Gender:F
Credentials:DNP, FNP, AG-ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11714 228TH ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIA HTS
Mailing Address - State:NY
Mailing Address - Zip Code:11411-1720
Mailing Address - Country:US
Mailing Address - Phone:917-856-3100
Mailing Address - Fax:
Practice Address - Street 1:1612 CENTRAL AVE FL 2
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-4002
Practice Address - Country:US
Practice Address - Phone:718-970-8700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-21
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF432306363LA2100X
NYF344328363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care