Provider Demographics
NPI:1740376136
Name:SULEWSKI, SUSAN FREAY (FNP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:FREAY
Last Name:SULEWSKI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 WEBSTER RD
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-9562
Mailing Address - Country:US
Mailing Address - Phone:585-265-9379
Mailing Address - Fax:585-265-9379
Practice Address - Street 1:3875 E HENRIETTA RD
Practice Address - Street 2:
Practice Address - City:HENRIETTA
Practice Address - State:NY
Practice Address - Zip Code:14467-9147
Practice Address - Country:US
Practice Address - Phone:585-334-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF332169363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02049521Medicaid
NYBB7412Medicare UPIN
NYBB7412Medicare ID - Type Unspecified