Provider Demographics
NPI:1477849339
Name:VACHON, SUSAN ALEXIS (PA)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:ALEXIS
Last Name:VACHON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:548 MARKET ST STE 94061
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94104-5401
Mailing Address - Country:US
Mailing Address - Phone:800-321-6879
Mailing Address - Fax:844-214-4888
Practice Address - Street 1:548 MARKET ST STE 94061
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94104-5401
Practice Address - Country:US
Practice Address - Phone:800-321-6879
Practice Address - Fax:844-214-4888
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA4933363AM0700X
MI5601007846363AM0700X
MN13026363AM0700X
NC0010-08972363AM0700X
IL085004729363AM0700X
NY23014386363AM0700X
NJ25MP00507400363AM0700X
NY014386363AM0700X
VA0110-005479363AM0700X
WI4653-23363AM0700X
CAPA16639363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical