Individual
CAROL A SUSTACHE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
407 GRAND AVE, SYRACUSE, NY 13204-2711
(315) 396-3731
Mailing address
407 GRAND AVE, SYRACUSE, NY 13204-2711
(315) 396-3731
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
277864
NY
Other
Enumeration date
09/11/2020
Last updated
09/11/2020
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