Provider Demographics
NPI:1881683274
Name:CALLAHAN, SUSAN W (NP)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:W
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 LEISURELY LN
Mailing Address - Street 2:
Mailing Address - City:BELLPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11713-2606
Mailing Address - Country:US
Mailing Address - Phone:631-286-9158
Mailing Address - Fax:
Practice Address - Street 1:HSC T19 020
Practice Address - Street 2:STONY BROOK UNIVERSITY HOSPITAL
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-0001
Practice Address - Country:US
Practice Address - Phone:631-444-8223
Practice Address - Fax:631-444-8947
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF301902363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health