Provider Demographics
NPI:1518086206
Name:WEGRZYN, SUSAN D (ANP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:D
Last Name:WEGRZYN
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 ORCHARD PARK RD.
Mailing Address - Street 2:SUITE A105
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-2654
Mailing Address - Country:US
Mailing Address - Phone:716-677-6000
Mailing Address - Fax:716-677-6006
Practice Address - Street 1:180 PARK CLUB LANE
Practice Address - Street 2:SUITE 100
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221
Practice Address - Country:US
Practice Address - Phone:716-839-9402
Practice Address - Fax:716-839-3570
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3045871363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner