Provider Demographics
NPI:1497019038
Name:MASON, SUZANNE E (SP ED TEACHER)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:E
Last Name:MASON
Suffix:
Gender:F
Credentials:SP ED TEACHER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1366 VIKING CIR
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-8544
Mailing Address - Country:US
Mailing Address - Phone:585-259-2652
Mailing Address - Fax:
Practice Address - Street 1:1366 VIKING CIR
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-8544
Practice Address - Country:US
Practice Address - Phone:585-259-2652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-28
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY903942991174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist