Provider Demographics
NPI:1437378635
Name:SUTTON, PHYLLIS ROACH (APRN, BC-PC)
Entity Type:Individual
Prefix:MS
First Name:PHYLLIS
Middle Name:ROACH
Last Name:SUTTON
Suffix:
Gender:F
Credentials:APRN, BC-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 1ST AVE
Mailing Address - Street 2:NYU MEDICAL CENTER H 183
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6402
Mailing Address - Country:US
Mailing Address - Phone:212-263-5572
Mailing Address - Fax:212-263-2099
Practice Address - Street 1:550 1ST AVE
Practice Address - Street 2:NYU MEDICAL CENTER H 183
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6402
Practice Address - Country:US
Practice Address - Phone:212-263-5572
Practice Address - Fax:212-263-2099
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF440013363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner