Healthcare Provider Details

I. General information

NPI: 1720876196
Provider Name (Legal Business Name): SUSAN SADICK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2025
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1143 NW 64TH TER STE A
GAINESVILLE FL
32605-4218
US

IV. Provider business mailing address

1143 NW 64TH TER STE A
GAINESVILLE FL
32605-4218
US

V. Phone/Fax

Practice location:
  • Phone: 352-331-1201
  • Fax:
Mailing address:
  • Phone: 352-331-1201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number9120675
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: