Healthcare Provider Details

I. General information

NPI: 1144848961
Provider Name (Legal Business Name): SUSANNA DELEON CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2020
Last Update Date: 07/08/2020
Certification Date: 07/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 CARROLL ST APT 7C
BROOKLYN NY
11215-1577
US

IV. Provider business mailing address

560 CARROLL ST APT 7C
BROOKLYN NY
11215-1577
US

V. Phone/Fax

Practice location:
  • Phone: 646-852-2142
  • Fax:
Mailing address:
  • Phone: 646-852-2142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License Number599332
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberF002000
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: