Provider Demographics
NPI:1013054808
Name:CAVANAGH, SUSAN T (NP, CNM)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:T
Last Name:CAVANAGH
Suffix:
Gender:F
Credentials:NP, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1985 CROMPOND RD
Mailing Address - Street 2:
Mailing Address - City:CORTLANDT MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10567-4146
Mailing Address - Country:US
Mailing Address - Phone:914-739-1697
Mailing Address - Fax:914-739-0973
Practice Address - Street 1:1985 CROMPOND RD
Practice Address - Street 2:BUILDING B
Practice Address - City:CORTLANDT MANOR
Practice Address - State:NY
Practice Address - Zip Code:10567-4146
Practice Address - Country:US
Practice Address - Phone:914-739-1697
Practice Address - Fax:914-739-0973
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY277534-1163WX0002X
NYF360158-1363LX0001X
NYF000117-1367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163WX0002XNursing Service ProvidersRegistered NurseObstetric, High-Risk
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology