Provider Demographics
NPI:1609568815
Name:LEIGH, SYUZANNA (PA-C)
Entity type:Individual
Prefix:
First Name:SYUZANNA
Middle Name:
Last Name:LEIGH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SYUZANNA
Other - Middle Name:
Other - Last Name:CHICHAKYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 KINGS HWY S
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-5504
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16 BANK ST
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-2250
Practice Address - Country:US
Practice Address - Phone:585-344-4800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-24
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029986363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant