MEDICARE: MRS. SUAN J VALENZUELA AGNP

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	363LA2200X	Adult Health Nurse Practitioner	312289	NY

General Provider Information

NPI Number	:	1639975014
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUAN J VALENZUELA AGNP

Provider Business Mailing Address
First Line	:	3550 LEXINGTON AVE
Second Line	:
City	:	MOHEGAN LAKE
State	:	NY
Zip	:	10547-1273
Country	:	US
Telephone Number	:	914-528-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	3550 LEXINGTON AVE
Second Line	:
City	:	MOHEGAN LAKE
State	:	NY
Zip	:	10547-1273
Country	:	US
Telephone Number	:	914-528-2000
Fax Number	:

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

Provider Enumeration Date	:	02/24/2025
Last Update Date	:	04/29/2025

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