Individual
SUSAN THERESA IANNACCONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5323 HARRY HINES BOULEVARD, DALLAS, TX 75390-7208
(214) 456-2768
(214) 456-6898
Mailing address
P.O. BOX 845347, DALLAS, TX 75284-5347
(214) 456-2768
(214) 456-6898
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
H8691
TX
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
H8691
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
105947903
—
TX
Enumeration date
03/27/2006
Last updated
04/26/2024
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