Healthcare Provider Details

I. General information

NPI: 1104823863
Provider Name (Legal Business Name): SUSAN MARIE TRAVIS CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 08/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 S RIVERSIDE AVE THE WESTCHESTER MEDICAL PRACTICE PC
CROTON ON HUDSON NY
10520-2653
US

IV. Provider business mailing address

50 DAYTON LANE, SUITE 202 THE WESTCHESTER MEDICAL PRACTICE PC
PEEKSKILL NY
10566
US

V. Phone/Fax

Practice location:
  • Phone: 914-271-2424
  • Fax: 914-271-2172
Mailing address:
  • Phone: 914-739-0087
  • Fax: 914-737-1714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberF381651-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: