Provider Demographics
NPI:1861972689
Name:STANFORTH, SUSAN CHRISTINE (FNP)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:CHRISTINE
Last Name:STANFORTH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:CHRISTINE
Other - Last Name:SLEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NONE
Mailing Address - Street 1:159 BARNEGAT RD STE 101
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-5402
Mailing Address - Country:US
Mailing Address - Phone:845-454-1942
Mailing Address - Fax:
Practice Address - Street 1:159 BARNEGAT RD STE 101
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-5402
Practice Address - Country:US
Practice Address - Phone:845-454-1942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF343473-1363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner