Individual
SUSAN REBECCA MITCHELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
79 GRAND AVE, MASSAPEQUA, NY 11758
(516) 798-3376
Mailing address
79 GRAND AVE, MASSAPEQUA, NY 11758-4905
(516) 798-3376
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
0173431
NY
Other
Enumeration date
02/24/2014
Last updated
03/23/2016
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