Provider Demographics
NPI:1881865533
Name:SUYONOV, ABO (PA)
Entity Type:Individual
Prefix:MR
First Name:ABO
Middle Name:
Last Name:SUYONOV
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:700 HICKSVILLE RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-3471
Mailing Address - Country:US
Mailing Address - Phone:516-576-6106
Mailing Address - Fax:516-576-5801
Practice Address - Street 1:700 HICKVILLE ROAD
Practice Address - Street 2:259 1ST STREET
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501
Practice Address - Country:US
Practice Address - Phone:516-663-8312
Practice Address - Fax:516-663-2184
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-20
Last Update Date:2017-11-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5601008481363A00000X
NY011213363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant