Healthcare Provider Details

I. General information

NPI: 1992952121
Provider Name (Legal Business Name): S AULL, MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2008
Last Update Date: 04/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5535 MARQUESAS CIR
SARASOTA FL
34233-3332
US

IV. Provider business mailing address

5535 MARQUESAS CIR
SARASOTA FL
34233-3332
US

V. Phone/Fax

Practice location:
  • Phone: 941-487-7244
  • Fax: 941-487-7245
Mailing address:
  • Phone: 941-487-7244
  • Fax: 941-487-7245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. SUSAN AULL
Title or Position: OWNER/PRESIDENT
Credential: M.D. P.A.
Phone: 941-364-9437