Provider Demographics
NPI:1124862495
Name:DALEY, SUZANNE MARIE (LPN)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:MARIE
Last Name:DALEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:MARIE
Other - Last Name:RADFORD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:322 VILLAGE BLVD S
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-3423
Mailing Address - Country:US
Mailing Address - Phone:332-288-8511
Mailing Address - Fax:
Practice Address - Street 1:322 VILLAGE BLVD S
Practice Address - Street 2:
Practice Address - City:BALDWINSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13027-3423
Practice Address - Country:US
Practice Address - Phone:332-288-8511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY308714-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty