Provider Demographics
NPI:1942611777
Name:CANNON, SUZANNE (RN)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:CANNON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 ONTARIO ST
Mailing Address - Street 2:
Mailing Address - City:HONEOYE FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14472-1149
Mailing Address - Country:US
Mailing Address - Phone:585-624-2121
Mailing Address - Fax:585-624-7283
Practice Address - Street 1:23 ONTARIO ST
Practice Address - Street 2:
Practice Address - City:HONEOYE FALLS
Practice Address - State:NY
Practice Address - Zip Code:14472-1149
Practice Address - Country:US
Practice Address - Phone:585-624-2121
Practice Address - Fax:585-624-7283
Is Sole Proprietor?:No
Enumeration Date:2014-05-14
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3303891207Q00000X
NY21320216163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator