Provider Demographics
NPI:1457188419
Name:BRYAN-DUDLEY, SUZZETTE GRACE (PROF INST SPECIALIST)
Entity type:Individual
Prefix:MRS
First Name:SUZZETTE
Middle Name:GRACE
Last Name:BRYAN-DUDLEY
Suffix:
Gender:F
Credentials:PROF INST SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:943 E 86TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-3805
Mailing Address - Country:US
Mailing Address - Phone:917-804-3930
Mailing Address - Fax:
Practice Address - Street 1:943 E 86TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-3805
Practice Address - Country:US
Practice Address - Phone:917-804-3930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1523485211174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist