Mayra Suero-Wade, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

042746 Issued in NY

Practice address

630 W 168TH St FL 3
Columbia University - Dentca
New York, NY 10032-3725

Phone

(201) 825-3073

NPI assigned

Oct 28, 2009

Last updated

Mar 30, 2012By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ, NY2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1256688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1333065600000",
    "number": "1467788240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "41 CAMERON RD",
            "city": "SADDLE RIVER",
            "state": "NJ",
            "postal_code": "074582944",
            "telephone_number": "201-825-4554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 W 168TH ST FL 3",
            "address_2": "COLUMBIA UNIVERSITY - DENTCA",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100323725",
            "telephone_number": "201-825-3073"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUERO-WADE",
        "first_name": "MAYRA",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-10-28",
        "last_updated": "2012-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MD",
            "license": "10775",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "042746",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NJ",
            "license": "22DI01675700",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Yamato Suemitsu
• Arleen Joyce Suen, M.A.
• Nancy Suen, O.D.
• Shernette T Suer, NP
• Leandra Nathalie Suero Diaz, P.A.
• Yurisa Stefanie Suero
• Anna L Suessbrick, PH.D.
• Marilyn Suffet, MW
• Sarah Suffir
• Mohammed Sufiyaan

• General Practice Dentistry in New York, NY
• Providers in New York, NY by specialty
• General Practice Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.