Individual
MRS. SUSAN BENTON SULESKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2503 S SEMINOLE TRL, MADISON, VA 22727-2690
(540) 948-6871
(540) 948-6601
Mailing address
PO BOX 21975, BELFAST, ME 04915-4116
(540) 321-4281
(540) 321-4282
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110-003217
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1982928735
—
VA
01
—
VVP063A
MEDICARE
VA
Enumeration date
03/23/2010
Last updated
05/17/2019
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