Provider Demographics
NPI:1518934983
Name:DAIUTO, SUSAN ANNE (DO)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:ANNE
Last Name:DAIUTO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 NATICK ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-1625
Mailing Address - Country:US
Mailing Address - Phone:718-668-1241
Mailing Address - Fax:718-980-0974
Practice Address - Street 1:1534 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-3529
Practice Address - Country:US
Practice Address - Phone:718-980-5437
Practice Address - Fax:718-980-0974
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY196996208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics