Provider Demographics
NPI:1932091691
Name:REYNOSO, SUE-EM LOPEZ (PHD)
Entity type:Individual
Prefix:
First Name:SUE-EM
Middle Name:LOPEZ
Last Name:REYNOSO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 KNOLLWOOD RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ELMSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:10523-2806
Mailing Address - Country:US
Mailing Address - Phone:845-999-0078
Mailing Address - Fax:
Practice Address - Street 1:45 KNOLLWOOD RD STE 100
Practice Address - Street 2:
Practice Address - City:ELMSFORD
Practice Address - State:NY
Practice Address - Zip Code:10523-2806
Practice Address - Country:US
Practice Address - Phone:845-999-0078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-17
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness CoachGroup - Single Specialty
No174H00000XOther Service ProvidersHealth Educator