Healthcare Provider Details

I. General information

NPI: 1417001165
Provider Name (Legal Business Name): SUZIE A NORONHA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 07/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE
ROCHESTER NY
14642-0001
US

IV. Provider business mailing address

PO BOX 777 601 ELMWOOD AVE
ROCHESTER NY
14642-0001
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-2981
  • Fax: 585-273-1039
Mailing address:
  • Phone: 585-275-2981
  • Fax: 585-273-1039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number267153
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License NumberD0063317
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: