Provider Demographics
NPI:1649612367
Name:SUFALKO, ASHLEY OLIVIA (CPNP)
Entity type:Individual
Prefix:MISS
First Name:ASHLEY
Middle Name:OLIVIA
Last Name:SUFALKO
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 JARRETT CT
Mailing Address - Street 2:
Mailing Address - City:PRINCETON JUNCTION
Mailing Address - State:NJ
Mailing Address - Zip Code:08550-2214
Mailing Address - Country:US
Mailing Address - Phone:609-915-9510
Mailing Address - Fax:
Practice Address - Street 1:2217 BRISTOL PIKE
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-5720
Practice Address - Country:US
Practice Address - Phone:215-638-0555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-23
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY658489-1163W00000X
PASP013943363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse