Provider Demographics
NPI:1942883038
Name:BUCKLEY, SUSAN ZELDA (NP)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:ZELDA
Last Name:BUCKLEY
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 1:7746 FARMWOOD RD
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER POINT
Mailing Address - State:VA
Mailing Address - Zip Code:23062-2202
Mailing Address - Country:US
Mailing Address - Phone:757-869-2830
Mailing Address - Fax:
Practice Address - Street 1:12720 MCMANUS BLVD STE 307
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-4414
Practice Address - Country:US
Practice Address - Phone:757-599-3436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-05
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024180001363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner