Provider Demographics
NPI:1477669711
Name:ROMEO, SUSAN (MS, RN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:ROMEO
Suffix:
Gender:F
Credentials:MS, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8200 SENECA TPKE
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NY
Mailing Address - Zip Code:13323-1027
Mailing Address - Country:US
Mailing Address - Phone:315-725-0403
Mailing Address - Fax:
Practice Address - Street 1:8200 SENECA TPKE
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NY
Practice Address - Zip Code:13323-1027
Practice Address - Country:US
Practice Address - Phone:315-725-0403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF380713363LP0200X
NY380713163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF380713OtherNEW YORK STATE LICENSE
NY6687718OtherNURSE PRACTITIONER IN PEDIATRICS, INACTIVE