Provider Demographics
NPI:1770741555
Name:SORRENTINO, SUSANNA (MD)
Entity type:Individual
Prefix:DR
First Name:SUSANNA
Middle Name:
Last Name:SORRENTINO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2538 ANTHEM VILLAGE DR STE 110
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-5551
Mailing Address - Country:US
Mailing Address - Phone:702-732-6800
Mailing Address - Fax:702-932-9611
Practice Address - Street 1:2538 ANTHEM VILLAGE DR STE 110
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-5551
Practice Address - Country:US
Practice Address - Phone:702-732-6800
Practice Address - Fax:702-932-9611
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-28
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY244966207SG0201X
NV18040207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1770741555Medicaid