Provider Demographics
NPI:1548201692
Name:SINNOTT, SUZANNE C (PA)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:C
Last Name:SINNOTT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10082 COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-6201
Mailing Address - Country:US
Mailing Address - Phone:301-295-4290
Mailing Address - Fax:301-319-7081
Practice Address - Street 1:2480 LLEWELLYN AVE
Practice Address - Street 2:
Practice Address - City:FORT MEADE
Practice Address - State:MD
Practice Address - Zip Code:20755-7081
Practice Address - Country:US
Practice Address - Phone:301-677-8796
Practice Address - Fax:301-677-8491
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC01687363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS83695Medicare UPIN
MDF622Medicare ID - Type Unspecified