Provider Demographics
NPI:1982140760
Name:HYDE, SUSAN N (ATP)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:N
Last Name:HYDE
Suffix:
Gender:F
Credentials:ATP
Other - Prefix:MRS
Other - First Name:SUSAN
Other - Middle Name:N
Other - Last Name:MAHONEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATP
Mailing Address - Street 1:1555 ELM ST APT 3108
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-3525
Mailing Address - Country:US
Mailing Address - Phone:972-921-3045
Mailing Address - Fax:817-590-8277
Practice Address - Street 1:1555 ELM ST APT 3108
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201-3525
Practice Address - Country:US
Practice Address - Phone:972-921-3045
Practice Address - Fax:817-590-8277
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-17
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXATP87869332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment