Provider Demographics
NPI:1427814961
Name:SUHANEE, EON ANTONIO (LAC)
Entity type:Individual
Prefix:
First Name:EON
Middle Name:ANTONIO
Last Name:SUHANEE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 MINA RD
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11769-1826
Mailing Address - Country:US
Mailing Address - Phone:631-882-0164
Mailing Address - Fax:
Practice Address - Street 1:3 MINA RD
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:NY
Practice Address - Zip Code:11769-1826
Practice Address - Country:US
Practice Address - Phone:631-882-0164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-22
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007486171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist