Provider Demographics
NPI:1992917819
Name:AIELLO, SUSAN (NP)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:AIELLO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:STONY BROOK DEPT OF RADIOLOGY
Mailing Address - Street 2:HSC LEVEL 4, ROOM 120
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-8460
Mailing Address - Country:US
Mailing Address - Phone:631-444-2426
Mailing Address - Fax:631-444-7538
Practice Address - Street 1:STONY BROOK DEPT OF RADIOLOGY
Practice Address - Street 2:HSC LEVEL 4, ROOM 120
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8460
Practice Address - Country:US
Practice Address - Phone:631-444-2426
Practice Address - Fax:631-444-7538
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY5799828163W00000X
NY5499577363LA2200X
NYF381289363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics