Provider Demographics
NPI:1134189459
Name:DAVIS-SUSSER, SHIRLEY ANN (PSYD)
Entity type:Individual
Prefix:DR
First Name:SHIRLEY
Middle Name:ANN
Last Name:DAVIS-SUSSER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:SHIRL
Other - Middle Name:
Other - Last Name:ROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:48 LOOCKERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-5011
Mailing Address - Country:US
Mailing Address - Phone:845-471-8645
Mailing Address - Fax:845-471-7820
Practice Address - Street 1:48 LOOCKERMAN AVE
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-5011
Practice Address - Country:US
Practice Address - Phone:845-471-8645
Practice Address - Fax:845-471-7820
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010347103T00000X
NY010347-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6800096OtherGHI PIN#
NYV72001Medicare ID - Type Unspecified