Provider Demographics
NPI:1760731996
Name:JAVED, SUZZANNA
Entity type:Individual
Prefix:DR
First Name:SUZZANNA
Middle Name:
Last Name:JAVED
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 1:23 GORES DR
Mailing Address - Street 2:
Mailing Address - City:MASTIC
Mailing Address - State:NY
Mailing Address - Zip Code:11950-2007
Mailing Address - Country:US
Mailing Address - Phone:646-373-6844
Mailing Address - Fax:
Practice Address - Street 1:23 GORES DR
Practice Address - Street 2:
Practice Address - City:MASTIC
Practice Address - State:NY
Practice Address - Zip Code:11950-2007
Practice Address - Country:US
Practice Address - Phone:646-373-6844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-04
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No174400000XOther Service ProvidersSpecialist