Provider Demographics
NPI:1548242050
Name:WAITE, SUSAN M (NP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:WAITE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:M
Other - Last Name:OSHEA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1304 BUCKLEY RD
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13212-4302
Mailing Address - Country:US
Mailing Address - Phone:315-478-3311
Mailing Address - Fax:315-426-0796
Practice Address - Street 1:1304 BUCKLEY RD
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13212-4302
Practice Address - Country:US
Practice Address - Phone:315-478-3311
Practice Address - Fax:315-426-0796
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY301103363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRA7200Medicare ID - Type Unspecified
NYQ46505Medicare UPIN
NY34576AMedicare PIN