Provider Demographics
NPI:1336937283
Name:DEVITO, SUSAN J
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:J
Last Name:DEVITO
Suffix:
Gender:
Credentials:
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:J
Other - Last Name:DEVITO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:233 DESERT ARROYO CT
Mailing Address - Street 2:SUSAN DEVITO
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012
Mailing Address - Country:US
Mailing Address - Phone:702-506-4706
Mailing Address - Fax:
Practice Address - Street 1:710 CORONADO CENTER DR STE 110
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4290
Practice Address - Country:US
Practice Address - Phone:702-778-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-29
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No174H00000XOther Service ProvidersHealth Educator