Healthcare Provider Details

I. General information

NPI: 1669414355
Provider Name (Legal Business Name): SUZANNE PAVLOU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 01/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 S. OLD DIXIE HWY JUPITER MEDICAL CENTER
JUPITER FL
33458
US

IV. Provider business mailing address

1210 S OLD DIXIE HWY JUPITER MEDICAL CENTER
JUPITER FL
33458-7205
US

V. Phone/Fax

Practice location:
  • Phone: 561-263-2234
  • Fax:
Mailing address:
  • Phone: 561-263-2234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME 90011
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01068644A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA07348200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: