Healthcare Provider Details

I. General information

NPI: 1528388915
Provider Name (Legal Business Name): SUZANNA ATTIA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2010
Last Update Date: 08/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 S LIMESTONE ST
LEXINGTON KY
40536
US

IV. Provider business mailing address

86 W UNDERWOOD ST STE 202
ORLANDO FL
32806-1110
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-6211
  • Fax: 859-257-7799
Mailing address:
  • Phone: 407-649-6876
  • Fax: 407-872-0544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTRN14987
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number51667
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: