Provider Demographics
NPI:1851097604
Name:LARNYOH, SUSANA BY
Entity Type:Individual
Prefix:
First Name:SUSANA
Middle Name:BY
Last Name:LARNYOH
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 1:10134 AMERICAN PHAROAH LN UNIT B
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723-2086
Mailing Address - Country:US
Mailing Address - Phone:240-543-0441
Mailing Address - Fax:
Practice Address - Street 1:10134 AMERICAN PHAROAH LN
Practice Address - Street 2:UNIT B
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20723-2086
Practice Address - Country:US
Practice Address - Phone:240-543-0441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-03
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR217662163W00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse