Provider Demographics
NPI:1851007942
Name:SURPRIS, ANN VALERIE
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:VALERIE
Last Name:SURPRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 HOWELLS RD
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-6503
Mailing Address - Country:US
Mailing Address - Phone:631-358-0869
Mailing Address - Fax:
Practice Address - Street 1:34 HOWELLS RD
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-6503
Practice Address - Country:US
Practice Address - Phone:631-358-0869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program