Provider Demographics
NPI:1407854813
Name:CAMPANARO, SUZI (DPM)
Entity Type:Individual
Prefix:
First Name:SUZI
Middle Name:
Last Name:CAMPANARO
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4955 W TAFT RD
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-4811
Mailing Address - Country:US
Mailing Address - Phone:315-457-0254
Mailing Address - Fax:315-234-7455
Practice Address - Street 1:4955 W TAFT RD
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-4811
Practice Address - Country:US
Practice Address - Phone:315-457-0254
Practice Address - Fax:315-234-7455
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNO4328213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine