Provider Demographics
NPI:1982318945
Name:MATHEW, SUBY (CRNP)
Entity Type:Individual
Prefix:
First Name:SUBY
Middle Name:
Last Name:MATHEW
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 N SIDESADDLE LN
Mailing Address - Street 2:
Mailing Address - City:EAST FALLOWFIELD TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:19320-4556
Mailing Address - Country:US
Mailing Address - Phone:215-450-7180
Mailing Address - Fax:
Practice Address - Street 1:2000 GREENBRIAR LN
Practice Address - Street 2:
Practice Address - City:WEST GROVE
Practice Address - State:PA
Practice Address - Zip Code:19390-9485
Practice Address - Country:US
Practice Address - Phone:215-450-7180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP026950363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty