Healthcare Provider Details

I. General information

NPI: 1497970909
Provider Name (Legal Business Name): ISLAND PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 37TH PL SUITE 101
VERO BEACH FL
32960-6586
US

IV. Provider business mailing address

960 37TH PL SUITE 101
VERO BEACH FL
32960-6586
US

V. Phone/Fax

Practice location:
  • Phone: 772-562-5662
  • Fax: 772-562-5702
Mailing address:
  • Phone: 772-562-5662
  • Fax: 772-562-5702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SUSAN B O'TOOLE
Title or Position: OWNER
Credential: M.D.
Phone: 772-562-5662