Healthcare Provider Details

I. General information

NPI: 1811649635
Provider Name (Legal Business Name): GIANNA SUYUNOVA MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2022
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: 646-915-4705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: GIANNA SUYUNOVA
Title or Position: OWNER
Credential:
Phone: 347-201-5507