Provider Demographics
NPI:1710786231
Name:MCCABE, SUSAN (ANP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:MCCABE
Suffix:
Gender:
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 MEADOW BEACH LN
Mailing Address - Street 2:
Mailing Address - City:MATTITUCK
Mailing Address - State:NY
Mailing Address - Zip Code:11952-2651
Mailing Address - Country:US
Mailing Address - Phone:516-449-6084
Mailing Address - Fax:
Practice Address - Street 1:135 MEADOW BEACH LN
Practice Address - Street 2:
Practice Address - City:MATTITUCK
Practice Address - State:NY
Practice Address - Zip Code:11952-2651
Practice Address - Country:US
Practice Address - Phone:516-449-6084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-08
Last Update Date:2025-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF301658-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health