# SUSY ALIAS

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1750332680
- **Gender:** F
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 204D00000X | Neuromusculoskeletal Medicine & OMM Physician | R9895 | MO | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | R9895 | MO | Yes |

## Other

- **Enumeration date:** 05/15/2006
- **Last updated:** 07/13/2026

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | NONE | PHYSICIAN | MO |