Provider Demographics
NPI:1497721757
Name:SURIANI, SAMMY F (PA)
Entity Type:Individual
Prefix:
First Name:SAMMY
Middle Name:F
Last Name:SURIANI
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 346
Mailing Address - Street 2:
Mailing Address - City:N SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13212-0346
Mailing Address - Country:US
Mailing Address - Phone:315-458-4622
Mailing Address - Fax:315-458-9629
Practice Address - Street 1:5180 W TAFT RD
Practice Address - Street 2:
Practice Address - City:N SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13212-2601
Practice Address - Country:US
Practice Address - Phone:315-458-4622
Practice Address - Fax:315-458-9629
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003379363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400080268Medicare PIN
NYQ51416Medicare UPIN