Provider Demographics
NPI:1477335438
Name:DODD, SUZANNA ELIZABETH (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:SUZANNA
Middle Name:ELIZABETH
Last Name:DODD
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 MARIA CT
Mailing Address - Street 2:
Mailing Address - City:REXFORD
Mailing Address - State:NY
Mailing Address - Zip Code:12148-1319
Mailing Address - Country:US
Mailing Address - Phone:518-322-7756
Mailing Address - Fax:
Practice Address - Street 1:7 MARIA CT
Practice Address - Street 2:
Practice Address - City:REXFORD
Practice Address - State:NY
Practice Address - Zip Code:12148-1319
Practice Address - Country:US
Practice Address - Phone:518-322-7756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-16
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2436644363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health