Healthcare Provider Details

I. General information

NPI: 1346851797
Provider Name (Legal Business Name): SUZY SAMEH FARAG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUZY SAMEH GUIRGUIS

II. Dates (important events)

Enumeration Date: 08/10/2020
Last Update Date: 01/31/2025
Certification Date: 01/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1776 N. WILLIAMSON BLVD.
DAYTONA BEACH FL
32117
US

IV. Provider business mailing address

1325 TOMOKA TOWN CENTER DRIVE APT 404
DAYTONA BEACH FL
32117
US

V. Phone/Fax

Practice location:
  • Phone: 386-323-7500
  • Fax: 203-573-7031
Mailing address:
  • Phone: 561-563-3331
  • Fax: 203-573-6707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number164827
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: