Provider Demographics
NPI:1821010380
Name:CONDRERAS, SUSAN M (PA)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:CONDRERAS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:640 S. STATE STREET
Mailing Address - Street 2:MAIL CODE 3055
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-3530
Mailing Address - Country:US
Mailing Address - Phone:302-480-1688
Mailing Address - Fax:302-480-9807
Practice Address - Street 1:101 WELLNESS WAY STE 300
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-4394
Practice Address - Country:US
Practice Address - Phone:302-503-2460
Practice Address - Fax:302-424-9162
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2023-09-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
DEC5-0001336363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5384170891Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER