Provider Demographics
NPI:1184948051
Name:MASSEY, SUZANNE ELISE (MED)
Entity type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:ELISE
Last Name:MASSEY
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4807 ROUND TOP RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-3115
Mailing Address - Country:US
Mailing Address - Phone:804-270-0165
Mailing Address - Fax:
Practice Address - Street 1:4807 ROUND TOP RD
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-3115
Practice Address - Country:US
Practice Address - Phone:804-270-0165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-22
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202003144235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist