MEDICARE: DR. SUZANNE DALE PHD

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	246QL0901X	Diplomate Laboratory Management Specialist/Technologist	DALES3	NY

General Provider Information

NPI Number	:	1790295061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUZANNE DALE PHD

Provider Business Mailing Address
First Line	:	810 TINKER TAVERN RD
Second Line	:
City	:	WEBSTER
State	:	NY
Zip	:	14580-8945
Country	:	US
Telephone Number	:	585-787-4420
Fax Number	:

Provider Business Practice Location Address
First Line	:	160 ELMGROVE PARK
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14624-1359
Country	:	US
Telephone Number	:	585-429-2360
Fax Number	:

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

Provider Enumeration Date	:	10/02/2017
Last Update Date	:	10/02/2017

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