Healthcare Provider Details

I. General information

NPI: 1679547665
Provider Name (Legal Business Name): SUSANA L. KUGEARES PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 03/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28322 OPENFIELD LOOP
WESLEY CHAPEL FL
33543-5705
US

IV. Provider business mailing address

28322 OPENFIELD LOOP
WESLEY CHAPEL FL
33543-5705
US

V. Phone/Fax

Practice location:
  • Phone: 813-892-8910
  • Fax:
Mailing address:
  • Phone: 813-892-8910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY7016
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: