Provider Demographics
NPI:1205115276
Name:SUYAMA, JOHN MICHIO (PHD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:MICHIO
Last Name:SUYAMA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BG CRAWFORD F. SAMS ARMY HEALTH CLINIC
Mailing Address - Street 2:UNIT 45011
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96343-5011
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:BG CRAWFORD F. SAMS ARMY HEALTH CLINIC
Practice Address - Street 2:UNIT 45011
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96343-5011
Practice Address - Country:US
Practice Address - Phone:315-263-4610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-09
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8782742-2501103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist