Healthcare Provider Details

I. General information

NPI: 1063054328
Provider Name (Legal Business Name): ALEXANDRA SUOZZO LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2019
Last Update Date: 10/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 SW 10TH ST
FORT LAUDERDALE FL
33315-1272
US

IV. Provider business mailing address

26 FIREMENS MEMORIAL DR STE 115
POMONA NY
10970-3569
US

V. Phone/Fax

Practice location:
  • Phone: 800-750-8616
  • Fax: 845-362-8474
Mailing address:
  • Phone: 845-362-8400
  • Fax: 845-362-8474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: