Provider Demographics
NPI:1962004325
Name:SOUTH-HYLTON, SUZAN (LPN)
Entity Type:Individual
Prefix:
First Name:SUZAN
Middle Name:
Last Name:SOUTH-HYLTON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 RIVERDALE AVE APT 2A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-4319
Mailing Address - Country:US
Mailing Address - Phone:345-453-3364
Mailing Address - Fax:
Practice Address - Street 1:91 RIVERDALE AVE APT 2A
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-4319
Practice Address - Country:US
Practice Address - Phone:347-453-3364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-11
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY338925164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse