Healthcare Provider Details

I. General information

NPI: 1720004161
Provider Name (Legal Business Name): SUSAN ELAINE STRED MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 05/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3229 E GENESEE ST STE. 1
SYRACUSE NY
13214-2016
US

IV. Provider business mailing address

3229 E GENESEE ST STE. 1
SYRACUSE NY
13214-2016
US

V. Phone/Fax

Practice location:
  • Phone: 315-464-5726
  • Fax: 315-464-2510
Mailing address:
  • Phone: 315-464-5726
  • Fax: 315-464-2510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number183126
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: