Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Susan Ingram

Individual provider Psychiatric/Mental Health Registered Nurse · NPI 1952779878

Susan Ingram is a Nurse Practitioner in Stony Brook, New York. Qualified in 2022, 4 years ago. Practices with Stony Brook Internists University Faculty Practice Corporation, a 428-clinician group and accepts Medicare assignment. Licensed in New York.

Years since qualifying
4
Licensed in
NY
In the registry since
2015
Specialties on file
2

Practice location Address checks out

101 Nicolls Rd
Stony Brook, NY 11794-1651
Phone: (631) 638-1000
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Adult Health Nurse Practitioner (primary) Taxonomy 363LA2200X · Licence 310911 (NY)
Psychiatric/Mental Health Registered Nurse Taxonomy 163WP0808X · Licence 704126-1 (NY)

Record details

NPI number1952779878
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedSeptember 9, 2015
Last updated in NPPESSeptember 23, 2022
Certification dateSeptember 23, 2022
Mailing address39 Clarendon St, Dix Hills, NY 11746-6933

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Group practice Stony Brook Internists University Faculty Practice Corporation — 428 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Stony Brook