Individual
SUELLEN NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.-C
Contact information
Practice address
969 MAIN ST, SUITE D, FISHKILL, NY 12524
(845) 896-7730
Mailing address
969 MAIN ST STE D, FISHKILL, NY 12524-1791
(845) 896-7730
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
003700
NY
363AS0400X
Surgical Physician Assistant
000463
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04956290
—
NY
01
—
A400085151
MEDICARE PTAN
NY
Enumeration date
02/28/2007
Last updated
06/15/2018
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