Provider Demographics
NPI:1548500895
Name:SUTHERLAND, PADI (CNM)
Entity type:Individual
Prefix:MS
First Name:PADI
Middle Name:
Last Name:SUTHERLAND
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 TROY SCHENECTADY RD STE 203
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2461
Mailing Address - Country:US
Mailing Address - Phone:518-783-3110
Mailing Address - Fax:518-782-3799
Practice Address - Street 1:700 MCCLELLAN ST STE 206
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12304
Practice Address - Country:US
Practice Address - Phone:518-370-7937
Practice Address - Fax:518-377-2983
Is Sole Proprietor?:No
Enumeration Date:2013-02-24
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9273632367A00000X
NYF001680-1367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008265400Medicaid