Healthcare Provider Details

I. General information

NPI: 1376745034
Provider Name (Legal Business Name): SUSAN MARIE SCOTT M.A. CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 06/03/2024
Certification Date: 06/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 W GRANADA BLVD
ORMOND BEACH FL
32174-8154
US

IV. Provider business mailing address

15280 NW 79TH CT STE 200
MIAMI LAKES FL
33016-5873
US

V. Phone/Fax

Practice location:
  • Phone: 386-255-4568
  • Fax:
Mailing address:
  • Phone: 305-558-3724
  • Fax: 786-907-4485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAY511
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: