Provider Demographics
NPI:1639975014
Name:VALENZUELA, SUAN J (AGNP)
Entity type:Individual
Prefix:MRS
First Name:SUAN
Middle Name:J
Last Name:VALENZUELA
Suffix:
Gender:
Credentials:AGNP
Other - Prefix:MRS
Other - First Name:SUAN
Other - Middle Name:J
Other - Last Name:VALENZUELA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AGNP
Mailing Address - Street 1:3550 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MOHEGAN LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:10547-1273
Mailing Address - Country:US
Mailing Address - Phone:914-528-2000
Mailing Address - Fax:
Practice Address - Street 1:3550 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:MOHEGAN LAKE
Practice Address - State:NY
Practice Address - Zip Code:10547-1273
Practice Address - Country:US
Practice Address - Phone:914-528-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-24
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY312289363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health