MEDICARE: SUSAN MARIE BLAIR KHAYYAT MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	18117	FL

General Provider Information

NPI Number	:	1134888084
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN MARIE BLAIR KHAYYAT MA

Provider Business Mailing Address
First Line	:	8305 SANTA CLARA BLVD
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34951-1019
Country	:	US
Telephone Number	:	772-971-2865
Fax Number	:

Provider Business Practice Location Address
First Line	:	8305 SANTA CLARA BLVD
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34951-1019
Country	:	US
Telephone Number	:	772-971-2865
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2021
Last Update Date	:	05/05/2026

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Directions to “ SUSAN MARIE BLAIR KHAYYAT MA” Practice Location

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