Healthcare Provider Details

I. General information

NPI: 1811200165
Provider Name (Legal Business Name): SUZANNE A SALHAB M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUZANNE A SALHAB M.D.

II. Dates (important events)

Enumeration Date: 07/15/2010
Last Update Date: 11/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11808 N 56TH ST
TEMPLE TERRACE FL
33617-1536
US

IV. Provider business mailing address

11808 N 56TH ST
TEMPLE TERRACE FL
33617-1536
US

V. Phone/Fax

Practice location:
  • Phone: 813-769-9866
  • Fax: 813-315-6313
Mailing address:
  • Phone: 813-769-9866
  • Fax: 813-315-6313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberME119290
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME119290
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME119290
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberME119290
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License NumberME119290
License Number StateFL
# 6
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberME119290
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: