Provider Demographics
NPI:1851262620
Name:MGDSYAN, SYUZANNA (FNP)
Entity type:Individual
Prefix:
First Name:SYUZANNA
Middle Name:
Last Name:MGDSYAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 W ACACIA AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-2288
Mailing Address - Country:US
Mailing Address - Phone:818-681-8889
Mailing Address - Fax:
Practice Address - Street 1:317 W ACACIA AVE APT 1
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-2288
Practice Address - Country:US
Practice Address - Phone:818-681-8889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-15
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95035168363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty