MEDICARE: IRISNEIDA A SUERO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	812175	NY
2	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1598516957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRISNEIDA A SUERO

Provider Business Mailing Address
First Line	:	12125 8TH AVE
Second Line	:
City	:	COLLEGE POINT
State	:	NY
Zip	:	11356-1156
Country	:	US
Telephone Number	:	917-600-8102
Fax Number	:

Provider Business Practice Location Address
First Line	:	12125 8TH AVE
Second Line	:
City	:	COLLEGE POINT
State	:	NY
Zip	:	11356-1156
Country	:	US
Telephone Number	:	917-600-8102
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/01/2024
Last Update Date	:	12/20/2024

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Directions to “ IRISNEIDA A SUERO ” Practice Location

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