Provider Demographics
NPI:1124389994
Name:VARDANOV, SUSANNA (TSHH)
Entity type:Individual
Prefix:MRS
First Name:SUSANNA
Middle Name:
Last Name:VARDANOV
Suffix:
Gender:F
Credentials:TSHH
Other - Prefix:
Other - First Name:SUSANNA
Other - Middle Name:
Other - Last Name:GILIAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2855 OCEAN AVE APT 3B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-3142
Mailing Address - Country:US
Mailing Address - Phone:718-975-0363
Mailing Address - Fax:
Practice Address - Street 1:2855 OCEAN AVE APT 3B
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-3142
Practice Address - Country:US
Practice Address - Phone:718-975-0363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist