Healthcare Provider Details

I. General information

NPI: 1942836788
Provider Name (Legal Business Name): VICTORIA CATHERINE SUTO PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2020
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 CECIL B MOORE AVE APT 204
PHILADELPHIA PA
19122-3243
US

IV. Provider business mailing address

PO BOX 3487
BUFFALO NY
14240-3487
US

V. Phone/Fax

Practice location:
  • Phone: 866-306-2026
  • Fax: 833-228-5591
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA064716
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number024801
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: