Healthcare Provider Details

I. General information

NPI: 1396017513
Provider Name (Legal Business Name): SUZANNE PAVLOU MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2012
Last Update Date: 02/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9858 CLINT MOORE RD SUITE C111-236
BOCA RATON FL
33496-1034
US

IV. Provider business mailing address

9858 CLINT MOORE RD SUITE C111-236
BOCA RATON FL
33496-1034
US

V. Phone/Fax

Practice location:
  • Phone: 561-676-7488
  • Fax: 561-910-4785
Mailing address:
  • Phone: 561-676-7488
  • Fax: 561-910-4785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME90011
License Number StateFL

VIII. Authorized Official

Name: SUZANNE PAVLOU
Title or Position: MANAGING MEMBER
Credential: MD
Phone: 561-676-7488