Provider Demographics
NPI:1548469497
Name:SORIA, SUZANNE (PA)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:SORIA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3249
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-2149
Mailing Address - Country:US
Mailing Address - Phone:860-896-1422
Mailing Address - Fax:860-896-1425
Practice Address - Street 1:192 E CENTER ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-5210
Practice Address - Country:US
Practice Address - Phone:860-649-3243
Practice Address - Fax:860-649-5092
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001912363A00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine