Provider Demographics
NPI:1649318288
Name:DEBALSI, SUSAN LYNNE (PA-C)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:LYNNE
Last Name:DEBALSI
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:200 MILL RD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-5252
Mailing Address - Country:US
Mailing Address - Phone:508-973-3000
Mailing Address - Fax:508-973-2001
Practice Address - Street 1:200 MILL ROAD
Practice Address - Street 2:SUITE 190
Practice Address - City:FAIRHAVEN
Practice Address - State:MA
Practice Address - Zip Code:02719
Practice Address - Country:US
Practice Address - Phone:508-973-2160
Practice Address - Fax:508-973-2176
Is Sole Proprietor?:No
Enumeration Date:2007-02-04
Last Update Date:2024-10-31
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Provider Licenses
StateLicense IDTaxonomies
MA1212363AM0700X
RIPA00663363AM0700X
MAPA1212363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical