Healthcare Provider Details

I. General information

NPI: 1922452341
Provider Name (Legal Business Name): SUZANNE MARIE HENDERSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2016
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

570 PRICE AVE STE 400
REDWOOD CITY CA
94063-1452
US

IV. Provider business mailing address

570 PRICE AVE STE 400
REDWOOD CITY CA
94063-1452
US

V. Phone/Fax

Practice location:
  • Phone: 650-466-6224
  • Fax: 650-466-6219
Mailing address:
  • Phone: 650-466-6224
  • Fax: 650-466-6219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA178697
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberA178697
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: