Provider Demographics
NPI:1750335089
Name:DRAGO, SUSAN P (RPA-C, MPAS)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:P
Last Name:DRAGO
Suffix:
Gender:F
Credentials:RPA-C, MPAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:4526 WHITETAIL CT
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-5449
Mailing Address - Country:US
Mailing Address - Phone:716-649-6380
Mailing Address - Fax:716-649-6380
Practice Address - Street 1:4535 SOUTHWESTERN BLVD
Practice Address - Street 2:SEDONA HOLISTIC MEDICAL CENTRE
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-1860
Practice Address - Country:US
Practice Address - Phone:716-646-6075
Practice Address - Fax:716-649-6380
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY006123363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02429367Medicaid
NYS49964Medicare UPIN