MEDICARE: SUHASINI NEELAM SATISH PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	25MP00704400	NJ

General Provider Information

NPI Number	:	1003588054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUHASINI NEELAM SATISH PA-C

Provider Business Mailing Address
First Line	:	205 PRESTWICK WAY
Second Line	:
City	:	EDISON
State	:	NJ
Zip	:	08820-4676
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	234 E 149TH ST BRONX
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10451
Country	:	US
Telephone Number	:	718-579-5000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2021
Last Update Date	:	12/30/2025

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