Provider Demographics
NPI:1922452341
Name:HENDERSON, SUZANNE MARIE (MD)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:MARIE
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 PRICE AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063-1452
Mailing Address - Country:US
Mailing Address - Phone:650-466-6224
Mailing Address - Fax:650-466-6219
Practice Address - Street 1:570 PRICE AVE STE 400
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-1452
Practice Address - Country:US
Practice Address - Phone:650-466-6224
Practice Address - Fax:650-466-6219
Is Sole Proprietor?:No
Enumeration Date:2016-04-21
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA178697208000000X, 207K00000X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics