Healthcare Provider Details

I. General information

NPI: 1811716061
Provider Name (Legal Business Name): SUZETTE J MADANAT PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2024
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 ALDEN ST
MEADVILLE PA
16335-2348
US

IV. Provider business mailing address

1034 GROVE ST
MEADVILLE PA
16335-2945
US

V. Phone/Fax

Practice location:
  • Phone: 814-373-5266
  • Fax: 814-373-5269
Mailing address:
  • Phone: 814-333-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS020195
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: