Provider Demographics
NPI:1700669744
Name:SYLVESTER, SUSZANNE MARY
Entity type:Individual
Prefix:MRS
First Name:SUSZANNE
Middle Name:MARY
Last Name:SYLVESTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 UPPER MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08879-1419
Mailing Address - Country:US
Mailing Address - Phone:908-461-4004
Mailing Address - Fax:
Practice Address - Street 1:860 UPPER MAIN ST
Practice Address - Street 2:
Practice Address - City:SOUTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08879-1419
Practice Address - Country:US
Practice Address - Phone:908-461-4004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NP04602900164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse