Provider Demographics
NPI:1417200635
Name:SUTHERLAND, DEEDRIAN (CNA)
Entity Type:Individual
Prefix:
First Name:DEEDRIAN
Middle Name:
Last Name:SUTHERLAND
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13727 THURSTON ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11413-2638
Mailing Address - Country:US
Mailing Address - Phone:646-763-7343
Mailing Address - Fax:
Practice Address - Street 1:13727 THURSTON ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11413-2638
Practice Address - Country:US
Practice Address - Phone:646-763-7343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-25
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY342757481208E376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide