Provider Demographics
NPI:1265287916
Name:DIRESTO, SUSAN (RN)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:DIRESTO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6120 GRAND CENTRAL PKWY APT B1206
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-1243
Mailing Address - Country:US
Mailing Address - Phone:646-644-0651
Mailing Address - Fax:
Practice Address - Street 1:6120 GRAND CENTRAL PKWY APT B1206
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-1243
Practice Address - Country:US
Practice Address - Phone:646-644-0651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY612866163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse