Provider Demographics
NPI:1942707161
Name:RYAN, SUZETTE REBECCA (DNP, NP, CNS, RN)
Entity Type:Individual
Prefix:DR
First Name:SUZETTE
Middle Name:REBECCA
Last Name:RYAN
Suffix:
Gender:F
Credentials:DNP, NP, CNS, RN
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Mailing Address - Street 1:1009 E 86TH STREET
Mailing Address - Street 2:APARTMENT 3
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236
Mailing Address - Country:US
Mailing Address - Phone:917-402-7374
Mailing Address - Fax:347-492-7732
Practice Address - Street 1:660 LOUISIANA AVENUE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11239
Practice Address - Country:US
Practice Address - Phone:718-669-7100
Practice Address - Fax:718-669-7547
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-13
Last Update Date:2023-10-18
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Provider Licenses
StateLicense IDTaxonomies
NY559546-1163W00000X
NY599546163W00000X
NYF308644-1363L00000X, 363LA2200X
NY599546-1364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist