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NPI Code Detail

MEDICARE: PHOEBE PRISCILLA SULISTIO

MEDICARE: PHOEBE PRISCILLA SULISTIO
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
1106S00000XBehavior TechnicianRBT-21-183500AL

General Provider Information

NPI Number : 1518638725
Entity Type Code : Individual
Provider Name (Legal Business Name) : PHOEBE PRISCILLA SULISTIO
Provider Business Mailing Address
First Line : 415 N RICHARD JACKSON BLVD
Second Line :
City : PANAMA CITY
State : FL
Zip : 32407-3664
Country : US
Telephone Number : 850-866-0441
Fax Number : 850-254-0827
Provider Business Practice Location Address
First Line : 6125 UNIVERSITY DR NW STE B22
Second Line :
City : HUNTSVILLE
State : AL
Zip : 35806-1765
Country : US
Telephone Number : 256-692-9262
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/27/2021
Last Update Date : 09/27/2021

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Directions to “ PHOEBE PRISCILLA SULISTIO ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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