Individual
MRS. GRACE JACQUELINE DESUCRE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
161 FORT WASHINGTON AVE FL 5, NEW YORK, NY 10032-3729
(212) 932-5169
Mailing address
302 ESSEX CT, BREWSTER, NY 10509-6533
(203) 550-2037
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
016203
NY
Other
Enumeration date
11/01/2012
Last updated
04/16/2018
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