Provider Demographics
NPI:1447447008
Name:ADE, SUSAN WALSH (APRN, RN)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:WALSH
Last Name:ADE
Suffix:
Gender:F
Credentials:APRN, RN
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:GRANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:67 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:CT
Mailing Address - Zip Code:06418-1328
Mailing Address - Country:US
Mailing Address - Phone:203-732-1330
Mailing Address - Fax:203-679-6873
Practice Address - Street 1:110 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-6244
Practice Address - Country:US
Practice Address - Phone:203-929-7331
Practice Address - Fax:203-925-0330
Is Sole Proprietor?:No
Enumeration Date:2007-09-27
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001755363LG0600X, 364SG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontology
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology