Healthcare Provider Details

I. General information

NPI: 1790133064
Provider Name (Legal Business Name): GIANNA SUYUNOVA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2016
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18904 UNION TPKE FL 1
FRESH MEADOWS NY
11366-1862
US

IV. Provider business mailing address

5 LANDAULETTE CT
MELVILLE NY
11747-1925
US

V. Phone/Fax

Practice location:
  • Phone: 347-201-5507
  • Fax: 646-233-3781
Mailing address:
  • Phone: 347-201-5507
  • Fax: 646-233-3781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number301217
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: