Provider Demographics
NPI:1487110714
Name:SUSSO, SANKUNG PAPA (EDD)
Entity type:Individual
Prefix:DR
First Name:SANKUNG
Middle Name:PAPA
Last Name:SUSSO
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 RITTER DR
Mailing Address - Street 2:
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-1213
Mailing Address - Country:US
Mailing Address - Phone:845-518-1369
Mailing Address - Fax:
Practice Address - Street 1:13 RITTER DR
Practice Address - Street 2:
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590-1213
Practice Address - Country:US
Practice Address - Phone:845-518-1369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-12
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency