Healthcare Provider Details

I. General information

NPI: 1154608917
Provider Name (Legal Business Name): SUZANNE MARIE WRAY R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2011
Last Update Date: 11/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 LITTLE BRITAIN RD STE 300
NEW WINDSOR NY
12553-5980
US

IV. Provider business mailing address

1145 LITTLE BRITAIN RD STE 300
NEW WINDSOR NY
12553-5980
US

V. Phone/Fax

Practice location:
  • Phone: 845-564-1855
  • Fax: 845-564-1902
Mailing address:
  • Phone: 845-564-1855
  • Fax: 845-564-1902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number426542-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: