Provider Demographics
NPI:1669837381
Name:SUYDAM, NICHOLAS (MS, PA-C, ATC)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:
Last Name:SUYDAM
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Gender:M
Credentials:MS, PA-C, ATC
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Mailing Address - Street 1:560 S LOOP RD
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:41017-3405
Mailing Address - Country:US
Mailing Address - Phone:859-301-2663
Mailing Address - Fax:859-817-7848
Practice Address - Street 1:4355 FERGUSON DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45245-5136
Practice Address - Country:US
Practice Address - Phone:513-232-2663
Practice Address - Fax:859-817-7848
Is Sole Proprietor?:No
Enumeration Date:2015-12-22
Last Update Date:2022-02-11
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical