Provider Demographics
NPI:1699194340
Name:EZE, ISUAN SUZY (MD)
Entity type:Individual
Prefix:
First Name:ISUAN
Middle Name:SUZY
Last Name:EZE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ISUAN
Other - Middle Name:SUZY
Other - Last Name:ASIKHIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ISUAN SUZY ASIKHIA
Mailing Address - Street 1:1010 E AND WEST RD
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-3602
Mailing Address - Country:US
Mailing Address - Phone:716-677-7000
Mailing Address - Fax:166-777-0737
Practice Address - Street 1:1010 E AND WEST RD
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-3602
Practice Address - Country:US
Practice Address - Phone:716-677-7000
Practice Address - Fax:716-677-7073
Is Sole Proprietor?:No
Enumeration Date:2014-04-09
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2193172084P0804X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05243325Medicaid