Healthcare Provider Details

I. General information

NPI: 1942246830
Provider Name (Legal Business Name): SUSANNAH B GARIEPY AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4714 LAKE CHARLES WAY N
KENNETH CITY FL
33709-3618
US

IV. Provider business mailing address

4714 LAKE CHARLES WAY N
KENNETH CITY FL
33709-3618
US

V. Phone/Fax

Practice location:
  • Phone: 727-504-7070
  • Fax: 727-767-8998
Mailing address:
  • Phone: 727-504-7070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAY1048
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: