Provider Demographics
NPI:1427184167
Name:TOBIAS, SUSAN PANDOLFI (NP)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:PANDOLFI
Last Name:TOBIAS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1083 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14209-1635
Mailing Address - Country:US
Mailing Address - Phone:716-882-1023
Mailing Address - Fax:716-882-1022
Practice Address - Street 1:1083 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14209-1635
Practice Address - Country:US
Practice Address - Phone:716-882-1023
Practice Address - Fax:716-882-1022
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF300746-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health