Provider Demographics
NPI:1265612147
Name:DIRIENZO, SUZANNE JANE (PA-C)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:JANE
Last Name:DIRIENZO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 DATAW DR
Mailing Address - Street 2:
Mailing Address - City:SAINT HELENA ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29920-3806
Mailing Address - Country:US
Mailing Address - Phone:917-593-0428
Mailing Address - Fax:
Practice Address - Street 1:1PINCKNEY BLVD.
Practice Address - Street 2:NAVAL HOSPITAL AT BEAUFORT
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902
Practice Address - Country:US
Practice Address - Phone:843-228-5577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-08
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004661363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical