Provider Demographics
NPI:1649237892
Name:HEFFERAN, SUZANNE M (DPM)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:M
Last Name:HEFFERAN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:SUZANNE
Other - Middle Name:M
Other - Last Name:SCHIMENTI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPM
Mailing Address - Street 1:24 WEST AVENUE
Mailing Address - Street 2:
Mailing Address - City:SPENCERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14559-1344
Mailing Address - Country:US
Mailing Address - Phone:585-352-5211
Mailing Address - Fax:585-352-5218
Practice Address - Street 1:24 WEST AVENUE
Practice Address - Street 2:
Practice Address - City:SPENCERPORT
Practice Address - State:NY
Practice Address - Zip Code:14559-1344
Practice Address - Country:US
Practice Address - Phone:585-352-5211
Practice Address - Fax:585-352-5218
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005280213E00000X, 213ES0131X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01692153Medicaid
NYBP3813296OtherDEA NUMBER
NY01692153Medicaid
NYBP3813296OtherDEA NUMBER