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Individual

MS. SUSAN BLAKE LYONS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA

Contact information

Practice address
3 TOUNTAS AVE, SUITE 3, LE ROY, NY 14482-1368
(585) 767-4220
(585) 768-8165
Mailing address
3 TOUNTAS AVE, SUITE 3, LE ROY, NY 14482-1368
(585) 767-4220
(585) 768-8165

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
004828
NY
363AM0700X
Medical Physician Assistant

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
02395962
NY
Enumeration date
06/27/2006
Last updated
09/23/2011
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