Healthcare Provider Details

I. General information

NPI: 1689739260
Provider Name (Legal Business Name): SUSANN M TEEGARDEN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 12/08/2021
Certification Date: 12/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1270 BELMONT AVE
SCHENECTADY NY
12308-2104
US

IV. Provider business mailing address

PO BOX 14890
ALBANY NY
12212-4890
US

V. Phone/Fax

Practice location:
  • Phone: 518-382-4560
  • Fax: 518-386-3619
Mailing address:
  • Phone: 518-525-5634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number331499
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: