Provider Demographics
NPI:1790295061
Name:DALE, SUZANNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:
Last Name:DALE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 TINKER TAVERN RD
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-8945
Mailing Address - Country:US
Mailing Address - Phone:585-787-4420
Mailing Address - Fax:
Practice Address - Street 1:160 ELMGROVE PARK
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-1359
Practice Address - Country:US
Practice Address - Phone:585-429-2360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-02
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYDALES3246QL0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QL0901XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyLaboratory Management, Diplomate