Provider Demographics
NPI:1023162369
Name:PISCATELLI, SUSAN FRANCES (LO)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:FRANCES
Last Name:PISCATELLI
Suffix:
Gender:F
Credentials:LO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:SHORELINE EYE ASSOCIATES
Mailing Address - Street 2:515 BOSTON ST.
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-2960
Mailing Address - Country:US
Mailing Address - Phone:203-453-8700
Mailing Address - Fax:203-458-9456
Practice Address - Street 1:SHORELINE EYE ASSOCIATES
Practice Address - Street 2:515 BOSTON ST.
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-2960
Practice Address - Country:US
Practice Address - Phone:203-453-8700
Practice Address - Fax:203-458-9456
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001096156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1282160001Medicare PIN