Healthcare Provider Details

I. General information

NPI: 1699840868
Provider Name (Legal Business Name): SUZANNE FALLON SAMUELS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 PARNASSUS AVE SUITE A101
SAN FRANCISCO CA
94143
US

IV. Provider business mailing address

505 PARNASSUS AVE BOX 0106
SAN FRANCISCO CA
94143
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-2770
  • Fax: 415-353-2657
Mailing address:
  • Phone: 415-353-2770
  • Fax: 415-353-2657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number583477
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number15059
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code364SP0200X
TaxonomyPediatric Clinical Nurse Specialist
License Number2117
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: