Healthcare Provider Details

I. General information

NPI: 1821379710
Provider Name (Legal Business Name): SUZANNE MARIE LANGTRY WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2011
Last Update Date: 12/21/2025
Certification Date: 12/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 N SEWARD AVE
AUBURN NY
13021-2149
US

IV. Provider business mailing address

6788 FRAZIER RD
MORAVIA NY
13118-3384
US

V. Phone/Fax

Practice location:
  • Phone: 315-253-9749
  • Fax:
Mailing address:
  • Phone: 607-745-5462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberF421046-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: