Provider Demographics
NPI:1477837581
Name:STANTON, SUSAN LYNN (PA-C)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:LYNN
Last Name:STANTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SUSIE
Other - Middle Name:
Other - Last Name:ROJC
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4952 FAIRLAWN RD
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:OH
Mailing Address - Zip Code:44124-1123
Mailing Address - Country:US
Mailing Address - Phone:440-478-8438
Mailing Address - Fax:
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:EPILEPSY DEPARTMENT
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:216-444-6771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-07
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.003363363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant