Provider Demographics
NPI:1407287055
Name:ZUPANCIC, SUSAN DUFFY
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:DUFFY
Last Name:ZUPANCIC
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 1:4205 IVYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:OH
Mailing Address - Zip Code:44144-1226
Mailing Address - Country:US
Mailing Address - Phone:216-403-7765
Mailing Address - Fax:
Practice Address - Street 1:4205 IVYWOOD DR
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:OH
Practice Address - Zip Code:44144-1226
Practice Address - Country:US
Practice Address - Phone:216-403-7765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-09
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.021376 T-Z225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist