Provider Demographics
NPI:1962285528
Name:DOTY, SUZANNA (PMHNP)
Entity type:Individual
Prefix:
First Name:SUZANNA
Middle Name:
Last Name:DOTY
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:SUZANNA
Other - Middle Name:
Other - Last Name:MCGUIRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:541 GRIFFITH VILLAGE LN
Mailing Address - Street 2:
Mailing Address - City:DAVIDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28036-8119
Mailing Address - Country:US
Mailing Address - Phone:843-300-5194
Mailing Address - Fax:
Practice Address - Street 1:4360 SHORE DR STE 101
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-2994
Practice Address - Country:US
Practice Address - Phone:757-302-3430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-17
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024187899363LP0808X
NC5018636363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health