Provider Demographics
NPI:1689100372
Name:SUFLITA, LORI A (MASTERS SPECIAL EDU)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:A
Last Name:SUFLITA
Suffix:
Gender:F
Credentials:MASTERS SPECIAL EDU
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 GIOVANNI CT
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-3915
Mailing Address - Country:US
Mailing Address - Phone:845-238-0114
Mailing Address - Fax:
Practice Address - Street 1:192 TOWER DR STE 400
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10941-2057
Practice Address - Country:US
Practice Address - Phone:845-238-0114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-02
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY868439981174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist