Provider Demographics
NPI:1932914249
Name:SUTPHIN, ALEXIS MERCEDES
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:MERCEDES
Last Name:SUTPHIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 RIVERWALK WAY
Mailing Address - Street 2:
Mailing Address - City:COHOES
Mailing Address - State:NY
Mailing Address - Zip Code:12047-3337
Mailing Address - Country:US
Mailing Address - Phone:518-683-5609
Mailing Address - Fax:
Practice Address - Street 1:18 S LAKE AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-1106
Practice Address - Country:US
Practice Address - Phone:518-436-7972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-12
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY929169163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent