Provider Demographics
NPI:1437304607
Name:SUTERA, JILL S (COTA)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:S
Last Name:SUTERA
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 UPPER RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-7000
Mailing Address - Country:US
Mailing Address - Phone:845-386-5685
Mailing Address - Fax:
Practice Address - Street 1:235 UPPER RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-7000
Practice Address - Country:US
Practice Address - Phone:845-386-5685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-01
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005184-1172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker