| NPI | 1679824908 |
|---|---|
| Former Name | STEPHANIE SUSINO |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NY 015963) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 015963) |
| Enumeration Date | 2012-09-26 |
| Last Update Date | 2024-04-10 |