| Doctor Name: | SUSAN FEDELE |
| NPI Number: | 1184040156 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 221859 |
| Business Practice Address: | 6715 Paradise Park Saranac, MI - 488818785 |
| Business Phone Number: | 6164020756 |
| Business Fax Number: | |
| Mailing Address: | 6715 Paradise Park, SARANAC |
| State: | MI |
| Postal Code: | 488818785 |
| Phone Number: | 6164020756 |
| Fax Number: | |
| NPI Enumeration Date: | 03/13/2014 |
| NPI Last Update Date: | 03/13/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2471M2300X |
| License Number: | 221859 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
| Taxonomy Classification: | Radiologic Technologist |
| Taxonomy Specialization: | Mammography |
| Taxonomy Definition: | |