Provider Demographics
NPI:1134411630
Name:FORDE, SUZANNE CASSANDRA (PA-C)
Entity type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:CASSANDRA
Last Name:FORDE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:1830 BROOKLYN AVE
Mailing Address - Street 2:APT. 4H
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-4250
Mailing Address - Country:US
Mailing Address - Phone:646-483-0851
Mailing Address - Fax:
Practice Address - Street 1:1850 BROOKLYN AVENUE
Practice Address - Street 2:APT. 4H
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-4248
Practice Address - Country:US
Practice Address - Phone:646-483-0851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-03
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013541363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical