Healthcare Provider Details

I. General information

NPI: 1609568815
Provider Name (Legal Business Name): SYUZANNA LEIGH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SYUZANNA CHICHAKYAN

II. Dates (important events)

Enumeration Date: 05/24/2023
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 RIVERVIEW AVE STE 202A
NORFOLK VA
23510-1065
US

IV. Provider business mailing address

100 KINGS HWY S
ROCHESTER NY
14617-5504
US

V. Phone/Fax

Practice location:
  • Phone: 757-252-9015
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number029986
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: