Healthcare Provider Details

I. General information

NPI: 1174864185
Provider Name (Legal Business Name): SUZE PACIUS PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2013
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 W MERRICK RD STE 201
FREEPORT NY
11520-3743
US

IV. Provider business mailing address

155 W MERRICK RD STE 201
FREEPORT NY
11520-3743
US

V. Phone/Fax

Practice location:
  • Phone: 516-726-4752
  • Fax: 516-400-0144
Mailing address:
  • Phone: 516-726-4752
  • Fax: 516-400-0144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number544028
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number403763
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: