Provider Demographics
NPI:1316298581
Name:DECAPUA, SUZANNE (PA-C)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:DECAPUA
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:192 TILLEY DR
Mailing Address - Street 2:UVM MEDICAL CENTER - ORTHOPEDICS
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-4440
Mailing Address - Country:US
Mailing Address - Phone:802-847-2663
Mailing Address - Fax:802-847-7470
Practice Address - Street 1:192 TILLEY DR
Practice Address - Street 2:UVM MEDICAL CENTER - ORTHOPEDICS
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-4440
Practice Address - Country:US
Practice Address - Phone:802-847-2663
Practice Address - Fax:802-847-7470
Is Sole Proprietor?:No
Enumeration Date:2012-09-27
Last Update Date:2015-12-17
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Provider Licenses
StateLicense IDTaxonomies
NY015919363A00000X
VT055.0031275363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant