Provider Demographics
NPI:1285874453
Name:DELLEA, SUSAN A (LIC ACUP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:A
Last Name:DELLEA
Suffix:
Gender:F
Credentials:LIC ACUP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1382
Mailing Address - Street 2:
Mailing Address - City:SANDWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02563-1382
Mailing Address - Country:US
Mailing Address - Phone:508-833-8567
Mailing Address - Fax:858-210-6379
Practice Address - Street 1:116 STATE ROAD #2
Practice Address - Street 2:
Practice Address - City:SAGAMORE BEACH
Practice Address - State:MA
Practice Address - Zip Code:02562-0256
Practice Address - Country:US
Practice Address - Phone:508-833-8567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-02
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA219605171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist