Healthcare Provider Details

I. General information

NPI: 1659457505
Provider Name (Legal Business Name): NICOLE J SUTTON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 12/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3415 BAINBRIDGE AVE
BRONX NY
10467-2403
US

IV. Provider business mailing address

3415 BAINBRIDGE AVENUE
NEW YORK NY
10028-4669
US

V. Phone/Fax

Practice location:
  • Phone: 718-741-2343
  • Fax: 718-920-4351
Mailing address:
  • Phone: 718-741-2343
  • Fax: 718-920-4351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number217408
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: