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General NPI Number Information
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NPI Number | 1851717292
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Entity Type | Individual
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Provider Name | SHELLY SUSKI PA-C
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Gender | Female
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Dates
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Enumeration Date | 03/10/2014
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Last Update Date | 08/25/2015
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Provider Practice Location Address
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Address Line | 100 TECHNOLOGY DR
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City | BUTLER
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State | PA
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Zip | 16001-1792
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Country | US
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Telephone | 724-482-2220
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Fax |
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Provider Business Mailing Address
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Address Line | 364 WEALDSTONE RD
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City | CRANBERRY TOWNSHIP
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State | PA
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Zip | 16066-8311
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Country | US
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Telephone | 724-984-9740
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | MA056762
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | OA003434
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License Number State | PA
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